Abortion in Hawaii

Abortion in Hawaii is legal. 66% of adults said in a poll by the Pew Research Center that abortion should be legal in all or most cases. Hawaii began allowing abortion on demand de jure in 1970, the first state to do so. State law enacted at that time stated said, “the State shall not deny or interfere with a female’s right to choose or obtain an abortion of a nonviable fetus or an abortion that is necessary to protect the life or health of the female.”

The number of abortion clinics in the state has been declining for years. There were 15 hospitals that performed abortions in 1970, 51 clinics in 1982, 52 clinics in 1992, six in 2011, four in 2014 and three in 2017. In 2017, women in rural parts of the state had trouble accessing abortion services because of lack of clinics and costs to travel. There were 3,643 abortions in 1970, 2,147 in 2014 and 3,200 in 2017.[1] Public funding existed for abortions for poor women using state Medicaid funding.  People in Hawaii participated in the #StoptheBans movement in May 2019.

Terminology
Main article: Abortion
See also: Definitions of abortion

The abortion debate most commonly relates to the "induced abortion" of an embryo or fetus at some point in a pregnancy, which is also how the term is used in a legal sense.[note 1] Some also use the term "elective abortion", which is used in relation to a claim to an unrestricted right of a woman to an abortion, whether or not she chooses to have one. The term elective abortion or voluntary abortion describes the interruption of pregnancy before viability at the request of the woman, but not for medical reasons.[2]

Anti-abortion advocates tend to use terms such as "unborn baby", "unborn child", or "pre-born child",[3][4] and see the medical terms "embryo", "zygote", and "fetus" as dehumanizing.[5][6] Both "pro-choice" and "pro-life" are examples of terms labeled as political framing: they are terms which purposely try to define their philosophies in the best possible light, while by definition attempting to describe their opposition in the worst possible light. "Pro-choice" implies that the alternative viewpoint is "anti-choice", while "pro-life" implies the alternative viewpoint is "pro-death" or "anti-life".[7] The Associated Press encourages journalists to use the terms "abortion rights" and "anti-abortion".[8]

Context
See also: Abortion in the United States

Free birth control correlates to teenage girls having a fewer pregnancies and fewer abortions. A 2014 New England Journal of Medicine study found such a link.  At the same time, a 2011 study by Center for Reproductive Rights and Ibis Reproductive Health also found that states with more abortion restrictions have higher rates of maternal death, higher rates of uninsured pregnant women, higher rates of infant and child deaths, higher rates of teen drug and alcohol abuse, and lower rates of cancer screening.[9]

According to a 2017 report from the Center for Reproductive Rights and Ibis Reproductive Health, states that tried to pass additional constraints on a women's ability to access legal abortions had fewer policies supporting women's health, maternal health and children's health.  These states also tended to resist expanding Medicaid, family leave, medical leave, and sex education in public schools.[10] According to Megan Donovan, a senior policy manager at the Guttmacher Institute, states have legislation seeking to protect a woman's right to access abortion services have the lowest rates of infant mortality in the United States.[10] Many of the state's poor, rural women rely on Title X services that provide family planning assistance, including prenatal carry. Under Donald Trump, these dollars have been cut in Hawaii, leaving poor and rural women particularly vulnerable when it comes to ability to access prenatal care.[11]

History

After Hawaii legalized abortion in 1970, the number of live births of children with Down syndrome decreased.[12] Women in rural Hawaii faced huge problems getting access to abortion services in 2017.[11] Women seeking abortions in 2017 often had to travel great distances, often paying more than $300 and take one or more days off and book accommodation, to get an abortion.  This could make the total cost of an abortion over US$1,000.[11]

Legislative history

In March 1970, not long before the Supreme Court made their decision in Roe v. Wade, Hawaii became the first state in the US to decriminalize abortion by removing all requirements to justify having the procedure done.  Both states retained one requirement for women seeking abortions, that was that the abortion be performed by a licensed physician at an accredited hospital.[13][14][15][16] There was a 90-day residency requirement in place at the time, and women were not required to provide a reason they were seeking an abortion[16][17] Alaska and Washington also joined Hawaii in repealing abortion that year.[13][18] In 1971, the state repealed its statute that said inducing an abortion was a criminal offense.[19] State law in 1971 required that any woman getting a legal abortion in the state needed to be a resident for some specific period between 30 and 90 days.[12]


As of May 14, 2019, the state prohibited abortions after the fetus was viable, generally some point between week 24 and 28. This period uses a standard defined by the US Supreme Court in 1973 with the Roe v. Wade ruling.[20] As of May 2019, state law on abortion said, “the State shall not deny or interfere with a female’s right to choose or obtain an abortion of a nonviable fetus or an abortion that is necessary to protect the life or health of the female.”[21][22]

Judicial history

The US Supreme Court's decision in 1973's Roe v. Wade ruling meant the state could no longer regulate abortion in the first trimester.[14]

Clinic history
Number of abortion clinics in Hawaii by year
Location of Hawaiian abortion clinics by island in 2017.
See also: Abortion clinic

Abortions in 1970 were required to take place in a hospital.  They cost around US$350, and 57.5% of women used personal funds or loans to cover the cost of their abortion. In 1970, the first year that abortion was legal in the state, abortions were performed at fifteen hospitals.[16] Between 1982 and 1992, the number of abortion clinics in the state increased by one, going from 51 in 1982 to 52 in 1992.[23] In 2011, there were only six clinics in the state, partly a result of the lack of doctors more generally in the state.[11] In 2014, there were four abortion clinics in the state.[24] In 2014, 40% of the counties in the state did not have an abortion clinic. That year, 5% of women in the state aged 15 – 44 lived in a county without an abortion clinic.[25] By 2017, there were only 3 clinics left.[11]

In 2017, 28 facilities in Hawaii provided abortion care with 4 of those facilities being clinics,[26] including two Planned Parenthood clinics.[27] Despite a demand on Kauai, an island of 67,000 people, there were no abortion clinics there in 2017.  Of Hawaii's eight major islands, only two islands have abortion clinics.[11]

Telehealth abortion services are currently available in Hawaii. Patient seeking a medical abortion are evaluated by a clinician using video conferencing. This service allows many women seeking abortion to avoid inter-island travel to an abortion clinic.[28]

Statistics

From March 1970 to December 1970, 3,643 abortions took place at 15 hospitals in the state, with an abortion to live birth rate of 1:45.[16] Demographics of women seeking abortions in Hawaii that year said that 47% were white, 21% were Japanese, 10% were Hawaiian, 8.4% were Filipino, 5.0% were Chinese, 54% had never been married, 51% had never been pregnant before 71% were in a relationship, 20% were teenagers.  Outside racial demographics, the profile of women getting abortions in Hawaii in 1970 was similar to that of other women in the United States.  Women getting abortions that year were more educated than the rest of women in childbearing range in the state. There were a variety of reasons these women had abortions including limiting family size or not using contraception.  Some had complications, with 22.5% of the complications being cervical laceration, 19.5% being hemorrhage and 16% infection.[16]

In 1990, 136,000 women in the state faced the risk of an unintended pregnancy.[23] In 2013, among white women aged 15–19, there were abortions 60, 10 abortions for black women aged 15–19, 50 abortions for Hispanic women aged 15–19, and 380 abortions for women of all other races.[29] In 2014, 66% of adults said in a poll by the Pew Research Center that abortion should be legal in all or most cases.[30] In 2017, the state had an infant mortality rate of 5.3 deaths per 1,000 live births.[10]

Number of reported abortions, abortion rate and percentage change in rate by geographic region and state in 2014, 2016, and 2017.[31]
Census division and stateNumberRate% change 2014–2017
201420162017201420162017
US Total926,190874,080862,32025.922.922.9-8
Alaska1,4701,2601,26010.08.68.6-14
California157,350140,700132,68019.517.416.4-16
Hawaii3,7603,1003,20014.011.612.0-14
Oregon9,3309,8509,64012.012.311.9-1
Washington19,23017,35017,74013.712.112.1-12
Number, rate, and ratio of reported abortions, by reporting area of residence and occurrence and by percentage of abortions obtained by out-of-state residents, US CDC estimates
LocationResidenceOccurrence% obtained by

out-of-state residents

 YearRef
No.Rate^Ratio^^No.Rate^Ratio^^
Hawaii 12,190 46 1992 [32]
Hawaii 7,510 29.3 1995 [32]
Hawaii 6,930 27.3 1996 [32]
Hawaii2,0117.51082,1478.01160.92014[33]
Hawaii2,0427.61112,0267.61100.32015[34]
Hawaii 2,479 9.3 137 2,554 9.6 141 1.0 2016 [35]
^number of abortions per 1,000 women aged 15-44; ^^number of abortions per 1,000 live births

Abortion financing
State Medicaid coverage of medically necessary abortion services.Navy blue: Medicaid covers medically necessary abortion for low-income women through legislationRoyal blue: Medicaid covers medically necessary abortions for low-income women under court order Gray: Medicaid denies abortion coverage for low-income women except for cases of rape, incest, or life endangerment.

Seventeen states including Hawaii use their own funds to cover all or most "medically necessary" abortions sought by low-income women under Medicaid, thirteen of which are required by State court orders to do so.[36] In 2010, the state had 1,279 publicly funded abortions, of which zero were federally and 1,279 were state funded.[37]

Abortion rights views and activities

Protests

Women from the state participated in marches supporting abortion rights as part of a #StoptheBans movement in May 2019.[38]

Views

Women in Film Executive Director Kirsten Schaffer said of Georgia and other states similar restrictive abortion bans passed in early 2019, “A woman’s right to make choices about her own body is fundamental to her personal and professional well-being. [...] We support people who make the choice not to take their production to Georgia or take a job in Georgia because of the draconian anti-choice law. To that end, we’ve compiled a list of pro-choice states that offer meaningful tax rebates and production incentives, and encourage everyone to explore these alternatives: California, Colorado, Hawaii, Illinois, Maine, Nevada, New Jersey, New Mexico, New York, Washington.”[39]

Footnotes
  1. According to the Supreme Court's decision in Roe v. Wade:
    (a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgement of the pregnant woman's attending physician. (b) For the stage subsequent to approximately the end of the first trimester, the State, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health. (c) For the stage subsequent to viability, the State in promoting its interest in the potentiality of human life may, if it chooses, regulate, and even proscribe, abortion except where it is necessary, in appropriate medical judgement, for the preservation of the life or health of the mother.
    Likewise, Black's Law Dictionary defines abortion as "knowing destruction" or "intentional expulsion or removal".

References
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  2. Watson, Katie (20 Dec 2019). "Why We Should Stop Using the Term "Elective Abortion"". AMA Journal of Ethics. 20: E1175-1180. doi:10.1001/amajethics.2018.1175. PMID 30585581. Retrieved 17 May 2019.
  3. Chamberlain, Pam; Hardisty, Jean (2007). "The Importance of the Political 'Framing' of Abortion". The Public Eye Magazine. 14 (1).
  4. "The Roberts Court Takes on Abortion". New York Times. November 5, 2006. Retrieved January 18, 2008.
  5. Brennan 'Dehumanizing the vulnerable' 2000
  6. Getek, Kathryn; Cunningham, Mark (February 1996). "A Sheep in Wolf's Clothing – Language and the Abortion Debate". Princeton Progressive Review.
  7. "Example of "anti-life" terminology" (PDF). Archived from the original (PDF) on 2011-07-27. Retrieved 2011-11-16.
  8. Goldstein, Norm, ed. The Associated Press Stylebook. Philadelphia: Basic Books, 2007.
  9. Castillo, Stephanie (2014-10-03). "States With More Abortion Restrictions Hurt Women's Health, Increase Risk For Maternal Death". Medical Daily. Retrieved 2019-05-27.
  10. "States pushing abortion bans have highest infant mortality rates". NBC News. Retrieved 2019-05-25.
  11. "Abortion access is a myth for rural women in Hawaii". Mother Jones. Retrieved 2019-05-28.
  12. Tyler, C. W. (1983). "The public health implications of abortion". Annual Review of Public Health. 4: 223–258. doi:10.1146/annurev.pu.04.050183.001255. ISSN 0163-7525. PMID 6860439.
  13. "Medicine: Abortion on Request". Time. March 9, 1970. Retrieved 2012-10-15. (subscription required)
  14. Buell, Samuel (1991-01-01). "Criminal Abortion Revisited". New York University Law Review. 66: 1774–1831.
  15. Tribune, Chicago. "Timeline of abortion laws and events". chicagotribune.com. Retrieved 2019-05-23.
  16. Diamond, M.; Palmore, J. A.; Smith, R. G.; Steinhoff, P. G. (1973). "Abortion in Hawaii". Family Planning Perspectives. 5 (1): 54–60. doi:10.2307/2133802. ISSN 0014-7354. JSTOR 2133802. PMID 4805720.
  17. Willke, J.C. (September 1992). "Very few illegal abortion deaths". American Journal of Obstetrics and Gynecology. 167 (3): 854. doi:10.1016/s0002-9378(11)91601-9. ISSN 0002-9378. PMID 1530050.
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  21. "Are there *any* states working to protect abortion rights?". Well+Good. 2019-05-17. Retrieved 2019-05-25.
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  24. Gould, Rebecca Harrington, Skye. "The number of abortion clinics in the US has plunged in the last decade — here's how many are in each state". Business Insider. Retrieved 2019-05-23.
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  27. "Here's Where Women Have Less Access to Planned Parenthood". Retrieved 2019-05-23.
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