Abortion Survey (copy)

Abortion rights activists and anti-abortion activists stand next to each other in front of the U.S. Supreme Court in Washington during a rally on the anniversary of the Roe v. Wade decision. 

WASHINGTON — Louisiana is set to play a pivotal role in the future of abortion access in the country, as the U.S. Supreme Court takes up its first major abortion case of the Trump era this week.

Louisiana's Act 620 would require abortion providers to have admitting privileges at a nearby hospital. It overwhelmingly passed the Louisiana Legislature in a bipartisan vote in 2014 and has since become the crux of the reproductive rights debate nationally.

It's already being trumpeted by supporters and opponents as a law that, if upheld, could pave the way for states to pass laws that tightly restrict, or potentially even ban, abortion — upending the court's landmark 1973 Roe v. Wade decision.

The Supreme Court struck down a Texas law in 2016 that was nearly identical to Act 620, ruling that it would create a “substantial obstacle in the path of a woman’s choice.”

But the court's make-up has significantly changed, and the state's legal team, under Attorney General Jeff Landry's leadership, argues that there are enough differences from the Texas law that should allow Louisiana's to pass muster.

Justices Neil Gorsuch and Brett Kavanaugh, both Trump appointees who have taken conservative positions in recent rulings, were not on the bench for the court's 5-3 Texas decision.

Just hours before the Louisiana law was set to take effect in February, the court narrowly voted for a temporary delay in its implementation. Gorsuch and Kavanaugh both sided with allowing it to go into effect, while Chief Justice John Roberts sided with the more liberal wing of the court — Justices Stephen Breyer, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan — on agreeing to the delay.

Louisiana has repeatedly been designated as the "most pro-life state" thanks to regulatory laws already in place that range from building codes to waiting periods.

If the admitting privileges law is allowed to take effect, it could signal a willingness by the court to sign off on other reproductive rights issues making their way through the legal system, such as fetal heartbeat laws that would end abortions after about six weeks, and laws that would require patients wait 72 hours between their first clinic visit and when a pregnancy can be terminated.

Louisiana currently bans abortion after 20 weeks and requires two doctors visits, 24 hours apart, before the procedure can be performed.

There are only three clinics across the state — one each in Shreveport, New Orleans and Baton Rouge, and there were fewer than 10,000 abortions in the state in 2017, according to the most recent figures available through the Guttmacher Institute, a research and policy outfit that supports abortion rights and tracks statistics. The number has been relatively stable since 2014, when there were 10,150. 

That's about 10.6 abortions for every 1,000 child-bearing aged women in the state, compared to the Southern regional average of 12.1. But not all of the patients who get abortions in Louisiana are from Louisiana, and some Louisiana residents may seek abortions in other states.

Abortion rights advocates argue the admitting privileges law is medically unnecessary and contradicts precedent the court set three years ago in the Texas case.

“The end-goal is to make states like Louisiana into an abortion desert,” said TJ Tu, an attorney for the Center for Reproductive Rights, which is leading the legal case against the Louisiana law. “They are systematically chipping away at abortion access.”

Those who support the law say its goal is to protect pregnant women and ensure adequate medical care if they experience complications.

"Louisiana abortionists have gone to extraordinary lengths to block this bipartisan law that promotes the well-being of women and protects minor girls who may find themselves in the hands of incompetent providers and under unsafe conditions," Louisiana Attorney General Jeff Landry's office wrote in a recent briefing on the case.

Landry didn't agree to an interview with The Advocate and The Times Picayune about it.

Only one of the six current abortion doctors in Louisiana, spread among the three clinics, currently meets the admitting privileges requirement. The Shreveport clinic doctor is also a full-time obstetrician at a local hospital that isn't identified in the court record.

According to legal filings by the law’s opponents, he would likely stop terminating pregnancies out of fear for his safety if he is the last remaining abortion doctor in the state, leaving none.

Supporters of the law say other doctors haven't tried hard enough to get the needed credentialing.

Landry, in his briefing, noted that four of the six abortion providers have had admitting privileges during some point in their medical careers.

"(And) hundreds of obstetrician/gynecologists and family practice doctors have privileges and are qualified to perform abortions if they chose to do so. A doctor’s decision on whether or not to perform abortions is a personal decision," the AG's briefing states.

Abortion-rights groups say they face additional hurdles because hospitals are anxious about facing a politically polarizing spotlight in a conservative state.

Kathaleen Pittman, administrator at Hope Medical Group For Women in Shreveport, said she sees it as “one of the many targeted laws Louisiana has passed in an attempt to shut down clinics.”

“I think it’s important everybody understand that (the law under Roe) becomes meaningless if there are no clinics,” she said.

Email Elizabeth Crisp at ecrisp@theadvocate.com and follow on Twitter, @elizabethcrisp.