TRAVELING FOR ABORTION SERVICES AND THE RURAL WOMEN 'WE MUST NOT FORGET'.

AuthorHaksgaard, Hannah

ABORTION ACROSS BORDERS: TRANSNATIONAL TRAVEL AND ACCESS TO ABORTION SERVICES. Edited by Christabelle Sethna and Gayle Davis. Johns Hopkins University Press, 2019. 360 pp. (ISBN-13: 978-1421427294, ISBN 10T42142729X).

A frequently under-discussed--yet incredibly relevant--aspect of abortion access is the travel that many women (1) must endure. Some women are lucky enough to live in jurisdictions where local hospitals perform abortions; other women live near abortion clinics. Even women who have local access to abortion services likely face other barriers. Those barriers may include--but are certainly not limited to--poverty, racialized barriers, immigration status, domestic violence, being a minor, childcare obligations, work obligations, and social stigma. But women without access to abortion in their home communities face all of those same barriers, and they must bear the sometimes-heavy costs--emotional, financial, and otherwise--of travel. In the edited volume Abortion across Borders: Transnational Travel and Access to Abortion Services, Christabelle Sethna and Gayle Davis collect twelve essays on travel and abortion. (2) Those twelve essays demonstrate the heavy costs that women face when they must travel for abortion. In addition to discussing social and psychological costs of travel, Abortion across Borders provides evidence that when local, safe, and legal abortion is not available, women face medical dangers from attempted self-abortions (3) and not having access to post-abortion medical care. (4)

The twelve essays in Abortion across Borders provide important context for policy discussions about abortion access. The book fills gaps in two fields. First, the literature on healthcare tourism has largely ignored abortion travel. (5) Second, the literature on abortion--with some notable exceptions--has been slow to embrace the impact travel has on women's access. (6) Sethna and Davis organize the twelve essays into three parts. Part I is historical in nature and focuses on international travel in the 1960s and 1970s. The three essays in Part I focus on travel to Sweden, London, and Australia. Part II includes historical and contemporary analysis and focuses on travel within individual countries, particularly where state or provincial governments have made access to abortion difficult or impossible. The five essays in Part II discuss Britain, Ireland, Australia, Texas, and Canada's Prince Edward Island. Finally, Part III includes essays that discuss changes to abortion access during "major shifts in governance." The four essays in Part III discuss regime-changes in Spain, the post-Cold War era in the former Yugoslav republic of Serbia, the shift away from communism in Poland alongside the continuing influence of the Catholic Church, and predictions about how Brexit may impact the ease with which other Europeans can access abortion in Britain.

Sethna posits that the three parts are "constructed largely around the following arguments:"

(1) legal and extralegal obstacles to abortion services in a specific healthcare jurisdiction must always be viewed through a transnational lens; (2) abortion services do not have to be illegal in order to be inaccessible; (3) domestic and international travel to access abortion services cannot be viewed as two distinct trends because they are profoundly interrelated responses to the existence of legal and extralegal obstacles to abortion services at local levels; (4) un-even access to abortion services in local healthcare jurisdictions reinforces or exacerbates discrimination by gender, race, class, sexuality, age, and region; and (5) by making gender in relation to other identity variables central, travel to access abortion services can enrich research on medical tourism. (7) These five arguments appear in various forms throughout the twelve essays, and in large part these arguments are important and comprehensive theses. A benefit of choosing to publish a collection of essays on this topic instead of a monograph is that various themes arise in different contexts, likely unintentionally. I found three repeated observations to be particularly salient.

Sethna articulates the first repeated observation: she argues the essays show domestic and international travel are interrelated and both types of travel occur because women cannot obtain abortions in their own communities. (8) This theme comes up repeatedly throughout the book, including an interesting discussion of how travel for abortion access has changed over time in Texas. Lori A. Brown discusses abortion policy in Texas and includes a discussion of how Texas women have travelled for abortion services over the years. Before Roe v. Wade, (9) American women traveled to Mexico (and other international destinations) to obtain abortions. (10) After Roe v. Wade and before the 2013 restrictive legislation in Texas known as "House Bill 2," there were forty-one abortion clinics operating in the state of Texas. (11) After the passage of House Bill 2, only nineteen clinics remained--fifteen of which are located in the three most populous Texas cities. (12)

Even before the passage of House Bill 2, many Texas women had to travel to abortion providers, but now large swaths of Texas women have no abortion providers in their communities, and an increased number have to travel further for services. (13) Importantly, Brown notes that "abortion clinics in states bordering Texas reported significant increases in new patients as a result of [House Bill 2] going into effect." (14) The Texas example provides clear support for a repeated theme in Abortion across Borders: by making abortion difficult to access, governments are not actually stopping abortions from happening. Rather, governments end up promoting self-abortion or travel as a consequence of more restrictive policies.

The changing norms of travel in Texas--from international travel to intrastate travel to inter-state travel--further supports the second repeated observation I find particularly salient. Abortion across Borders provides additional evidence that even those lawmakers who support restrictive abortion laws and policies assume that abortions will continue, and they acknowledge that those abortions will be performed in other jurisdictions or through illegal means. The book's introduction opens with a quote from American President Donald Trump acknowledging that if Roe v. Wade is overturned and some states ban abortion, abortion will not cease for women in those states, but rather those women will "have to go to another state." (15) Relatedly, Mary Gilmartin and Sinead Kennedy point out that historically "one of the many contradictions in Ireland's abortion laws is that [travel out-of-country for abortions] is assumed, and indeed expected." (16) Although Ireland recently voted to repeal its constitutional ban on abortion, (17) there are ongoing fights to decrease women's access...

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