Reproductive Rights in Kentucky

One of the bills would have required pre-abortion "counseling" to take place in person and allowed government officials to inspect patients' records, while the cynically named "Women's Health & Life Protection Act" would have banned abortion entirely unless the woman's life was in danger. Under this law, any doctor who performed an abortion, even for a survivor of rape or incest, would be prosecuted.

If this language sounds familiar, it's because a similar, unenforceable ban recently passed in South Dakota. And while Kentucky's bill lies dormant for now, residents are not out of the woods yet. Many pro-choice advocates in Kentucky have a wait-and-see attitude, because the issue could resurface in next year's legislative session.

Existing Restrictions

Pro-choice advocates in Kentucky have their hands full as it is; the Bluegrass State is already harsh country for reproductive rights. Take, as one example, the fact that Kentucky law requires a woman to notify her husband before having an abortion, even though the U.S. Supreme Court deemed such requirements unconstitutional in its 1992 Planned Parenthood v. Casey ruling.

The list of restrictions doesn't end there.

• Kentucky is one of four states with a "trigger law" that would immediately go into effect to ban abortion should Roe v. Wade be overturned.

• A woman must wait 24 hours before having an abortion. During this period, she must receive information about "medical risks and alternatives" to abortion, and she must be offered state-prepared literature titled Information About Fetal Development, which features descriptions and photographs of fetal growth.

• A woman under 18 must obtain written consent from one parent before having an abortion, even if the she is a survivor of abuse, assault, or incest. She may bypass the consent requirement only if her doctor certifies a "medical emergency," or if she can convince a judge that an abortion would be in her best interest.

• Providers may refuse to perform abortions because of their own personal biases. And despite the fact that there is no state refusal clause for emergency contraception (EC) on the books, 37 percent of Kentucky pharmacists, according to a recent survey, would refuse to fill a prescription for EC, while nearly half of Kentucky pharmacies (just over 300) do not carry EC at all.

• State law prohibits hospital staff from offering abortion counseling or referrals to survivors of sexual assault.

• In addition to standard medical regulations, abortion providers are subject to onerous administrative and regulatory laws, monitoring everything from personnel policy to facility layout. These regulations are thinly veiled attempts to increase costs for providers or close them down altogether.

• Only Kentucky-licensed physicians may perform abortions. Anti-choice states like Kentucky often compel clinics to look out of state for providers, so these types of restrictions can drastically limit services.

Only two clinics in all of Kentucky's 120 counties currently provide abortion. EMW Women's Surgical Center operates both of them — one is in Louisville and the other is in Lexington. Neither is able to accept insurance, because private insurance policies in Kentucky cover abortion only in cases in which the woman's life is in danger, and public employees are not offered abortion coverage at all. Medicaid funding for abortion is prohibited except in cases of rape, incest, and life endangerment.

Kentucky also plans to follow Tennessee's lead and sell "Choose Life" license plates. Drivers pay extra money for these plates. The proceeds go to so-called "pregnancy care centers" or "crisis pregnancy centers," deceptive anti-choice organizations masquerading as health centers. They try to dissuade women from getting abortions and offer such services as abstinence-only education, Bible studies, and counseling for so-called "post-abortion syndrome," a fake disorder disavowed by the American Psychological Association, among others.

The Poverty Problem

While these are formidable hurdles to reproductive health care in Kentucky, economics is often the biggest obstacle of all. In 2004, 12.7 percent of Americans were living below 100 percent of the federal poverty level; in Kentucky, that number was almost 18 percent, a percentage topped only by Mississippi.

More than 40 percent of Kentuckians — almost two million people — live in rural areas. For the low-income women living in these regions, just getting to Louisville or Lexington can be a hardship. (The biased "counseling" that is required 24 hours before an abortion can currently take place via phone. But had a proposed bill passed this session, women would have had to make two trips into town or stay overnight to receive this information in person.)

And then there's the matter of insurance, which will not cover the $400 to $600 cost of an abortion. Says EMW's founder and Executive Director Dona Wells, "We don't come close to meeting the needs of low-income women in Kentucky."

Kentucky's two Planned Parenthood affiliates, which offer education and preventive care services (but not abortion at this time), confront the same issue. Both receive Title X (federal family planning) funding, but because Title X has not kept pace with inflation, funding has decreased over the past few years even as the number of uninsured people has risen, according to Shirley Jones, CEO of Planned Parenthood of Louisville (PPL). Jones's clinic, for example, received no additional Title X funding this year, even though the number of PPL patients at or below 150 percent of the poverty level increased by almost 30 percent in 2005.

(Blue)grassroots Campaigning

"I think our main challenge is how to generate a grassroots movement in a state that is largely rural," says Jones. "Opportunities don't necessarily exist to present [diverse] viewpoints. As a result, educating people about reproductive freedom doesn't get the same forum it might in cities or suburbs."

A particular challenge, says Jones, is the ongoing confusion between EC (also known as the "morning-after pill") and mifepristone medication abortion (also known as "RU-486"). Even some state pharmacists, she says, still believe that EC, which prevents pregnancy from occurring, is the same as mifepristone, which prevents an existing pregnancy from continuing. There are "strong advocates within the community," Jones says, but "there's still a lot of educating we need to do."

For her part, Wells would like more hospitals to teach abortion procedures. She is also committed to political change. "There are many pro-choice people around here," says Wells. "State leaders need to hear their voices before an abortion ban is reintroduced or before Roe is overturned."

"We have to work together," says Jones, echoing Kentucky's state motto: "United We Stand, Divided We Fall."

© 2006 Planned Parenthood Federation of America, Inc. All rights reserved.