This report presents findings from a qualitative study examining state, local, and institutional policies in Virginia—one of the only remaining states in the South post-Dobbs with legal access to abortion care past 13 weeks gestational age. The authors reviewed legislation, bills, and sources detailing the policy landscape in Virginia and interviewed clinicians and nonclinicians working at organizations providing or supporting abortion care.

Understanding the State and Local Policies Affecting Abortion Care Administration, Access, and Delivery

A Case Study in Virginia

Julia Rollison, Skye A. Miner, Maya Buenaventura, Rachel Holzer, Yoony Lee, Mekdes Shiferaw

ResearchPublished Sep 23, 2024

The patchwork of laws and regulations that affect abortion access in the United States has become increasingly complex since the 2022 Dobbs v. Jackson Women’s Health Organization U.S. Supreme Court decision that gave states the right to enact and enforce policies facilitating or restricting abortion access. The authors examined state, local, and institutional policies in Virginia—which is one of the only remaining states in the South post-Dobbs with legal access to abortion care past 13 weeks gestational age—to better understand how the policy landscape is influencing provision of care in the state.

The authors reviewed existing legislation, bills, and sources detailing the policy landscape in Virginia and interviewed a sample of clinicians and nonclinicians working at organizations providing or supporting abortion care. The study principally focused on state laws, local policies and actions, institutional policies, and reported implementation experiences affecting access to abortion care.

Key Findings

  • Although Virginia's laws surrounding reproductive care became more permissive in 2020, abortion remains in the criminal code.
  • Advanced practice registered nurses are allowed to provide abortion care in the first trimester.
  • An abortion occurring in the third trimester must be certified by three physicians as necessary for the patient's health and performed in a licensed hospital.
  • Some state provisions on abortion care before the third trimester were noted as affecting access, including a lack of clarity on some provisions and how to interpret them, particularly the ability to provide second-trimester abortions in nonhospital settings.
  • Unemancipated minors must obtain parental or guardian consent or receive a judicial bypass of the parental-consent requirement.
  • State-based Medicaid funding is available only in limited circumstances.
  • Institutional-level policies on gestational age limits were often based on institution-specific definitions of "viability," the skill set and comfort level of the clinicians providing care, and the ability to transfer patients to a trusted nearby hospital.
  • Respondents reported that local zoning restrictions or permissions influenced their facility's ability to establish and maintain leases and exist in a stable and safe environment.
  • Respondents reported minimal impact of policies on providers but noted other nonpolicy barriers and challenges.
  • Respondents reported that marginalized populations, often including youth populations, were most affected by such regulations as minor consent requirements, and the lack of Medicaid coverage made accessing care more challenging.

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Citation

RAND Style Manual
Rollison, Julia, Skye A. Miner, Maya Buenaventura, Rachel Holzer, Yoony Lee, and Mekdes Shiferaw, Understanding the State and Local Policies Affecting Abortion Care Administration, Access, and Delivery: A Case Study in Virginia, RAND Corporation, RR-A3324-2, 2024. As of October 15, 2024: https://www.rand.org/pubs/research_reports/RRA3324-2.html
Chicago Manual of Style
Rollison, Julia, Skye A. Miner, Maya Buenaventura, Rachel Holzer, Yoony Lee, and Mekdes Shiferaw, Understanding the State and Local Policies Affecting Abortion Care Administration, Access, and Delivery: A Case Study in Virginia. Santa Monica, CA: RAND Corporation, 2024. https://www.rand.org/pubs/research_reports/RRA3324-2.html.
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Funding for this research was provided by a generous gift from Dana Guerin. This research was conducted in the Social and Behavioral Policy Program within RAND Social and Economic Well-Being.

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