By Sam Metz -
The Associated Press
Utah's Republican Gov. Spencer Cox signed legislation Wednesday that will ban clinics from performing abortions next year, sparking confusion among medical centers, hospitals and potential patients in this conservative state.
Hospital and clinic managers have not detailed their plans to adapt to the new law, adding further uncertainty to fears that if the centers close, women will not be able to access medical care in hospitals due to staffing problems and costs.
A Planned Parenthood clinic in Salt Lake City, Utah, on June 28, 2022. Rick Bowmer / AP
Both Planned Parenthood in Utah and the Utah Hospital Association declined to specify how this measure will affect abortion access in the state, where the situation was already tense for providers of this service.
The turmoil reflects developments in red states across the country since the Supreme Court struck down Roe v.
Wade last year, will transform the legal landscape and spark a series of lawsuits in at least 21 states.
Utah lawmakers had claimed the law would protect "the innocent" and "the unborn," saying they don't believe the state needs abortion clinics after the Supreme Court struck down the constitutional right to abortion.
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Although Planned Parenthood previously warned that the law could drastically hamper their ability to perform abortions, Jason Stevenson, a lobbyist for the association, said Wednesday that he will now look further at the wording of other provisions in the law that could allow clinics to request new licenses to perform services equivalent to those of a hospital.
Under Planned Parenthood's interpretation, clinics will no longer be able to perform abortions with their current licenses.
However, they plan to continue providing most of their services, such as pregnancy tests and cancer screening.
Stevenson said the organization is "looking carefully" at the licensing options provided under the law, but declined to say whether clinics would apply for them at this time.
Jill Vicory, a spokeswoman for the Utah Hospital Association, explained in an email that it was "too early to comment" on whether the hospitals could soon be the only abortion providers in Utah, noting that each "will have to make a decision." determination as to how they decide to proceed".
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If clinics stop performing abortions, experts worry that the comparatively higher cost of care and understaffing at hospitals will make it more difficult to perform legal abortions in Utah, even if the law does not explicitly restrict those who do. apply in the state, where it remains legal up to 18 weeks.
Dr. Carole Joffe, a professor at the University of California, San Francisco and author of articles on the social effects of reproductive health care, said that de-licensing clinics would upend the way abortions have been performed for decades. .
Historically, patients with low-complication pregnancies have aborted primarily in outpatient clinics, which on average can do so at a lower cost.
“Everything in a hospital is more expensive than in a clinic.
To do an abortion in a hospital you need more staff,” she said, noting that hospitals, with teams of anesthetists, doctors and surgeons, have historically practiced them in emergency situations.
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Another challenge facing already overburdened hospitals is staffing, Joffe said, both in terms of hiring and getting staff to perform abortions.
Especially in states where anti-abortion sentiment is very strong, many hospital doctors or nurses may not want to practice abortion, he added.
“You have to go to a group that may or may not be sympathetic to abortion, unlike in a clinic, where you're not going to work unless you commit to making abortion a part of healthcare,” Joffe said. .
Abortion advocates say the confusion stems from a lack of clarity about the license withdrawal process.
The law prohibits clinics from obtaining new licenses after May 2 and institutes a full ban on January 1, 2024. However, advocates are concerned about a separate provision in the 1,446-line bill that specifies under the law state that abortions can only be performed in hospitals.
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Clinic-focused legislation has also raised questions about what types of centers are best equipped to offer specialized care to patients, regardless of their socioeconomic status or location.
If the clinics stop performing abortions, either in May or next year, they could divert thousands of patients to hospitals and force administrators to devise new policies for elective abortions.
To do this they would have to expand their services beyond the emergency procedures they have offered so far, raising questions about the impact of the change on capacity, staffing, waiting lists and costs.
About 2,800 abortions were performed in Utah last year.
According to the Utah Hospital Association, no hospitals performed elective abortions in the state last year.
The new restrictions will most likely affect women who want to terminate a pregnancy with medication, which accounts for the majority of abortions in Utah and the United States.
Abortion medication is licensed up to 10 weeks into pregnancy, is prescribed primarily in clinics, and, since a pandemic-era FDA rule change, is increasingly being offered via telemedicine.
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The new law takes on added importance amid the legal limbo surrounding other abortion laws that have been signed in Utah.
Last year's Supreme Court ruling followed two previously passed laws: the ban on abortion after 18 weeks in 2019 and the ban on abortion regardless of trimester in 2020, with several exceptions, including cases of risk to the maternal health, as well as rape or incest reported to the police.
Planned Parenthood in Utah sued the 2020 ban, and in July a state court stayed its enforcement until legal challenges were resolved.
Since then, the 18-week ban has become de facto law.
Abortion access advocates have denounced this year's clinic ban as a back door that anti-abortion lawmakers are using to limit access while the courts deliberate.
If abortions were restricted regardless of trimester to exceptional circumstances, the closures would have less broad implications for patients pursuing elective abortions from zero to 18 weeks pregnant.
The law also clarifies the definition of abortion to address liability concerns raised by providers about the way exceptions are worded in state law — a provision the governor and Republican lawmakers called a compromise