Although it's always been a minor theme in pro-abortion advocacy, abortion "access" has been front and center lately, particularly when it comes to state requirements that abortionists have admitting privileges at local hospitals. The goal of this legislation is to stop the practice of (literal) fly-by-night abortionists, who come into town for abortions, fly back to their homes out of state, and leave the local ER to deal with any complications that arise. (In the non-abortion context, this is known as patient abandonment.) Abortion advocates see this legislation as a bad thing, of course, because they believe that a fly-by-night abortionist is better than no abortionist at all.
But look below the surface, and the pro-life legislation is only part of their complaint.
In states like New York and California, which have a long tradition of supporting abortion much more strongly than the American population as a whole, an admitting privileges law would have little or no effect (not that it would ever pass). It would be pointless because the abortionists there are local and plentiful.
It's only in states that are already culturally pro-life that this legislation matters at all: states where most of the medical profession upholds the Hippocratic oath, and where the only abortion "services" come from fly-by-nighters who are attracted to the area by the very fact that there's no competition.
But that competition is starting to get steep everywhere. The abortion rate in the United States is at a low point, as fewer women experience unplanned pregnancies, and more of those who do choose life. The trend is the same for teenagers. (These trends actually appeared before the recent surge in pro-life legislation; the statistics are always several years behind. The true rates today are surely even lower.)
In North Dakota, the owner of the state's only abortion business freely admits that, pro-life legislation aside, it just wouldn't make financial sense for a second business to open there. North Dakota has a population of roughly 723,000 people. Let's compare it to the District of Columbia, which has a population of about 646,000. Care to guess how many abortion business D.C. has? Five. (That's not counting Maryland and northern Virginia, which have its own.) Why? Because North Dakota has a pro-life culture, and a very low abortion rate to match. In contrast, D.C. has one of the highest abortion rates in the nation.
So what happens as pro-lifers win the cultural battle, and the country as a whole becomes less like D.C. and more like North Dakota? Fewer unplanned pregnancies and fewer abortions are, we're told, what pro-choice advocates want... or at least it was, before they stopped saying "rare."
The hard truth (for them) is that we could have the beginnings of a virtuous cycle on our hands. As people use more effective contraception and the pro-life view wins more hearts and minds, abortion businesses will have to either close or hike up their prices. As a result, abortions will decline even further. Eventually, even medical school graduates who are sympathetic to abortion will focus their talents elsewhere because there's just not enough money in it. And the abortions will decline even further...
So what happens when the end of abortion "access" is caused not by legislation, but by the natural ebb and flow of culture? How, in that circumstance, can you defend abortion as a constitutional right?
The "right" to abortion is somewhat unique in that it requires another participant to "exercise" it. The only possible analogy I can think of, if I were to assume for the sake of argument that abortion were a constitutional right, is a hypothetical (and, admittedly, extremely unlikely) world in which guns have become so unpopular that it's difficult for Second Amendment enthusiasts to find sellers of firearms.
How important is it to abortion supporters that a woman in a pro-life region has "access" to abortion? Would they be willing to conscript doctors? Willing to encourage unplanned pregnancies to drum up sufficient business? These questions may seem ridiculous now, and I'll admit I've allowed my imagination to run a bit free in this article. But if current trends continue, these are the questions that the abortion movement will have to confront in the next ten or fifteen years. There is a kernel of fundamental tension between the movement for "choice" and the movement for "access." They can coexist while there are a million abortions a year. But in the long run, in order to have access, a critical mass of women have to make the "right" choice.