Forty years ago, the Supreme Court ruled in that women have the federal legal right to abortions. Yet as abortion laws in some states have shown, the law doesn’t ensure accessibility. Strict state regulations and laws on abortion providers, facilities and practices has drastically limited the amount of abortion clinics in the country, and made it harder for patients to access care. This June, the Supreme Court is expected to rule in a case deciding whether or not abortion will be practically accessible, as the conversation shifts from Roe vs. Wade to Whole Woman’s Health v. Hellerstedt—deciding the future of safe abortion practices for women across the country.

“The key issue is access,” ACLU Executive Director Carol Rose said on Boston Public Radio. “The question is, whether you agree or don’t agree with it—should it be denied to people simply because they’re poor?”

According to Rose, the issue of access is a civil liberties problem when certain segments of people in rural or poor districts are deprived of care. “You can create these classes where people don’t have equal access,” she said. “Just like blocking the right to vote, there are lots of ways to block people’s right to obtain healthcare.”

The HB-2 law in Texas ordered that abortion providers must have admitting privileges at hospitals and meet the same standards of outpatients surgical centers. Because of the law, 19 of 40 abortion clinics in Texas closed after not meeting the legal requirements to operate. These laws, Rose says, seem to promote women’s health, but actually do the opposite. “Here’s the irony: Abortion is so safe that very few people need to go to the hospital to get it,” Rose said.

If abortions go well, it means the doctors won’t do very much hospital work. And because abortion doctors can’t perform their quota of surgeries, they lose their admitting privileges. “[Abortion] is very quick and it’s not risky, so the doctors have a hard time getting admitting privileges at hospitals, because they don’t do enough hospital work, because what they do is safe,” Rose said. “It’s one of those things that looks good on its face for protecting women, but in fact it’s actually denying the right to women.”

What are women going to do? They're going to start doing what they had to do in the bad old days, which was inducing themselves, and many will die, and it will be horrible.

Another law, approved by Virginia governor Bob McDonnell and spreading across the country (“like a fungus” in the words of Carol Rose) would hold abortion clinics to the same building standards as hospitals. This means hallways must be five  feet wide, exam rooms must be at least 80 square feet, and clinics must have at least four parking spaces for each surgical room. “They would have all the same requirements hospitals have, in terms of hygiene and facilities and temperature and all the other things that huge hospitals have...imagine doing that to dental offices around the country, how devastating that is,” Rose said. “If you perform something like a tooth impact, it has basically the same level of medical danger to the woman [as an abortion].”

If the Supreme Court rules in favor of these laws, Rose says, safety is at risk.  “What are women going to do? They’re going to start doing what they had to do in the bad old days,” Rose said, “which was inducing themselves, and many will die, and it will be horrible.”

In 1992, the Supreme Court ruled that access to abortion could not be limited by “undue burdens” from such state laws in Planned Parenthood vs. Casey. But the case also ruled that some limits could go into effect, if they could serve to protect the life of the mother. According to Rose, the Supreme Court reflects an effort to care for women, but the intention is misguided. “There’s been a fairly paternalistic protection of women,” she said, “and there’s a lot of literature coming from the anti choice perspective that is tied into that.”

Ultimately, Rose says that Whole Woman’s Health v. Hellerstedt comes down to fundamental human rights. “It’s an equal protection claim, basically,” she said. “It says everybody has to have equal access to whatever the rights are that are available. The notion that it becomes discriminatory based on people’s race or gender or their poverty status...once you go down that road, you begin to talk about equal rights. That’s why I really see abortion, as well as access to contraception and to neonatal care really is a question of giving women —and families, frankly, not just women—economic power. Anybody out there who has a child, you know how expensive it is. You know what a burden it is, and what a deep responsibility it is. We need to let families make these incredibly difficult private decisions away from the law and with access to making it as safe as possible.”

Carol Rose is executive director of the ACLU of Massachusetts. To hear her full interview with Boston Public Radio, click on the audio link above.