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Some women seeking abortions cross state lines

As abortion restrictions tighten in neighboring states, Maryland has become a destination for women seeking greater access to the procedure, according to officials.

Some laws in other states aimed at regulating clinics as stringently as hospitals have resulted in the shuttering of abortion facilities. Other implementations may prevent a woman from remaining in-state for the procedure.

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But some argue that this doesn't necessarily deter a woman from receiving an abortion. Rather, she'll just have to travel.

And if the woman resides in Pennsylvania or Virginia, two neighboring states that increased restrictions this year, Maryland is oftentimes where they'll go to seek a facility or to avoid counseling 24 hours before the procedure. Maryland is friendlier to abortion laws, its regulations more lax.

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"The distribution of abortion providers in Maryland - fairly liberal state, fairly liberal government - reflects economics," said Mark Graber, a University of Maryland law and government professor and author of "Rethinking Abortion." "The distribution of abortion clinics in many western states reflects hostility."

Per Maryland law, the state may not interfere with a woman's decision to terminate a pregnancy. A physician is the one who determines just what constitutes a viable fetus. The Maryland Department of Health and Mental Hygiene is not permitted to adopt regulations outside of established medical practices.

And that's less restrictive than most state laws, according to Amber Banks, outreach and communications coordinator for NARAL Pro-Choice Maryland, formerly known as the National Abortion and Reproductive Rights Action League.

"As far as our laws are concerned, Maryland women do not face the same obstacles that women in other states do in accessing abortion care," she said.

On average, 29 per 1,000 women of reproductive age had an abortion in Maryland in 2008, according to the Guttmacher Institute, which keeps tabs on the issue and seeks to advance sexual and reproductive health through research and analysis. This number is nearly 10 above the national average in 2008, the latest available data. Maryland represents 2.8 percent of all abortions performed in the United States.

About 63 percent of Maryland counties do not have an abortion provider, the nonprofit Guttmacher Institute last reported in 2008, meaning travel time may be involved. And that could mean missing a day of work and paying for gas or public transportation. However, the state does have at least a dozen clinics, which puts it ahead of other states in terms of availability, officials said.

"Compared to most states, access in Maryland is quite good," Graber said. "Could it be better? Yes. I don't think anybody has any doubt about that. But remember, how far is it from Carroll County to Baltimore or Annapolis or Silver Spring?"

All those trips can be made in 90 minutes or less. But generally, that's nothing compared to traveling to a different state for an abortion, he said.

But others in Maryland do think the restrictions could be better, advocating that abortion is the taking of a human life and the states implementing restrictions are taking steps in the right direction.

Sen. Edward R. Reilly, R-Anne Arundel, and Sen. Nancy Jacobs, R-Cecil and Harford, sponsored a bill in the 2013 legislative session that was similar to the one that recently passed in Texas prohibiting abortions 20 weeks post-fertilization. It died in the Senate Finance Committee. Del. Neil Parrott, R-Washington, sponsored the corresponding bill, which died in the House of Delegates Health and Government Operations Committee.

Steps such as these would increasingly tighten regulations, with the ultimate goal being an outright ban in Maryland and nationwide, Jack Ames, Defend Life director and founder, said.

Since that bill and others have not passed, Maryland still has fairly liberal laws.

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And historically, as states pass stricter regulations, such as Pennsylvania previously, patients come to Maryland from farther away, according to Diane Silas, Hagerstown Reproductive Health Services' administrator.

Typically, patients come to the Hagerstown Reproductive Health Services clinic from within a 100-mile radius of the office, she said. This includes women from various Maryland counties and bordering states.

Because, she said, women who choose the procedure are likely still going somewhere.

"It's very simple," she said. "If you're female, and you have sex, you can get pregnant. And some of those pregnancies are unwanted or impossible to continue."

If the choice becomes termination, then the next order of business is finding a clinic.

Most pro-choice advocates worry that restrictions force offices to close. Some pro-life proponents say that that isn't a bad thing, and these tightened regulations are actually protecting a woman's health. The busiest clinic in Virginia, NOVA's Women's Healthcare, closed this summer, according to various media reports.

"There are just larger hurdles to tackle in order to be able to gain access," Silas said. "As long as there [are clinics], you could make the argument that there is access, but the question is, how Herculean of an effort does one have to put forth in order to gain that access?"

Located in Baltimore County, Hillcrest Clinic sees many women from various counties across Maryland, and roughly 8 to 10 percent of its patients are from Carroll, according to Cheryl Wolf, Hillcrest's public affairs director. But it also sees a fair number from out-of-state.

Patients call to make an appointment. Depending on how busy the office is that day, the visit takes about four to six hours total. First, the clinic will complete necessary preliminary steps, such as garnering lab work and performing a pregnancy test and sonogram. Next, the woman will talk to a counselor, who will discuss post-operative instructions and ensure that the woman is confident in her decision.

"We also want to find out if they're secure that this is the best alternative that they have," Wolf said, "and that they're secure with their decision. That nobody's pushing them into it. That they're making the decision on their own."

A nurse will write up a medical history. Then the procedure is performed. After 30 to 45 minutes in the recovery room, the woman is ready to go, Wolf said. This process is typically done, on average, about 15 to 16 times a day at the Baltimore County clinic, according to Wolf.

Comparatively, the process takes at least two days in Pennsylvania. A patient is required to receive state-directed counseling and then wait at least 24 hours before having the procedure, according to the Guttmacher Institute.

Thus, Hillcrest Clinic sees a fair number of patients from Pennsylvania.

"A lot of people just don't want to do that, so they come here," Wolf said, "and it's close."

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Several other clinic officials said they see patients from Virginia. It's another state that has government-directed counseling, according to Guttmacher Institute's listing of state abortion laws, and recently required facilities to maintain hospital-like standards.

On occasion, officials said, they'll see patients from out of the country.

The number of clinics in Maryland has decreased over the years, according to Guttmacher Institute. There were 41 in 2005. There were 34 in 2008. DHMH did not oversee surgical abortion facilities until July 2012, so the department would be unable to comment on why they closed, according to Dori Henry, a DHMH spokeswoman.

And in mid-2012, there were 16 licensed surgical abortion facilities. Four had their licenses suspended in May, according to DHMH. This number doesn't include those clinics licensed under the ambulatory surgical facility category that might also perform the procedure.

So it's commonplace for women seeking an abortion in Maryland to venture outside their county to find the service.

The state's surgical abortion facilities are primarily concentrated in high-population areas. There are four in Montgomery, three in Prince George's, two in Baltimore County and one each in Anne Arundel and Washington counties and Baltimore city.

Carroll County does not have a clinic, nor has it had one in at least the last 30 years - if ever, according to Cindy Marucci-Bosley, Carroll County Health Department's nursing director.

But that's not necessarily problematic, said Vicki Saporta, National Abortion Federation's president and CEO.

"Not every county can support a freestanding abortion clinic," she said. "There's not enough women who need abortions in every single county in Maryland, so Maryland has fairly good access to abortion care throughout the state."

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