Editorial: Protect access to reproductive care

The overturning of the Roe v. Wade and Planned Parenthood v. Casey rulings, which for decades had supported a constitutional right to abortion nationwide, has drawn legal and legislative battle lines between the federal government and numerous states seeking to enforce their own individual bans of the procedure.

Fortunately, Hawaii, which legalized abortion three years before the U.S. Supreme Court did, has some distance from that heat of battle.

The push for women’s reproductive health here will look less like a combat zone than a more long-term campaign to make services more widely available — long needed but now even more urgent. Especially where doctor shortages are most acute on the neighbor islands, improved access and affordability for ending a pregnancy — and preventing one in the first place — is what truly matters.

However, the stunning political upheaval that has erupted since the high court’s June 24 ruling provides the backdrop that can’t be ignored.

The most current developments last week began with President Joe Biden signing an executive order. That aims to crack down on state or local officials interfering with a pregnant person traveling out of state to get an abortion where it’s legal. It also would help shield patient data indicating that an abortion is being sought.

In announcing the order, Biden cited the case of a 10-year-old girl, a rape victim from Ohio, where the abortion ban makes no exceptions for rape or incest. The girl had to travel to Indiana to get the procedure, and her physician there is now being eyed by the Indiana attorney general for a criminal prosecution.

At the point of the court rulings, observers had floated hypotheticals about what its repercussions could be. It hasn’t taken long for actual repercussions to be felt. This clearly will be a long, bitter fight, and not even a pre-teen rape victim will be sequestered from the brawl.

In addition, the debate extends to pharmaceuticals. HRA Pharma, a Paris-based company, is seeking Food and Drug Administration approval for U.S. use of an over-the-counter birth-control bill. Anything that can make family planning easier could be a help.

More controversially, medications such as the “morning after pill” are under fire; some say that specific birth control methods interfere with pregnancy and, therefore, should be illegal. All of this is bound to result in protracted challenges and legal battles.

Already Congress is facing off on either side of the issue. Hawaii’s delegation has issued statements uniformly opposed to the court rulings. The House on Friday passed two bills, H.R. 8296 and 8297, respectively to protect abortion providers and patients, and to bar penalties for those who travel for reproductive health care.

They lack the votes to pass in the Senate, but that chamber is taking action as well. U.S. Sen. Mazie Hirono is one of five Democrats introducing a bill to bar states from limiting travel for abortion services.

These actions are warranted. For all its geographic isolation, Hawaii certainly could be a destination for women to travel for services that their states won’t permit. Freedom to cross state lines to access legal medical care is foundational.

Some of Hawaii’s women will continue to have a persistent problem getting services, regardless. If anything, this niche in travel to Hawaii could put the state’s health-care system under more strain.

Even before the court rulings, advocates for reproductive care here worked to address the medical provider shortage. In 2021, the Legislature passed House Bill 576, authorizing advance-practice nurses and physicians assistants to perform abortions, both through clinical procedures and through medications.

In testimony delivered last year, Khara Jabola-Carolus, executive director of the Hawai‘i State Commission on the Status of Women, said the measure “would have a profound impact on women in rural and medically underserved communities.”

It may be too soon to gauge the effects of the law, but it’s a start. The Legislature in January should make a reinforcement of reproductive health care a high priority. Putting clinical care in easier reach of remote communities, adding clinic capacity, would be one promising route; so would reexamining insurance coverage that’s offered.

“Abortion providers are largely located on Oahu, Maui and on the Hilo side of the Big Island,” said Mack Smith, a spokeswoman for Planned Parenthood’s office for Hawaii, Alaska, Idaho, Indiana, Kentucky and Washington. “For people anywhere else in the state, they are often forced to travel or access abortion care via telehealth.”

Better care also means expanding access to contraception, and reviewing education and outreach to poorer families on options that are available to them.

Reproductive care has become the ultimate hot-button political issue. But it is also a family concern with real human consequences. Hawaii, for one, faces a long road ahead in addressing what very well could become its next health-care crisis.