How State and Local Policies Affect Abortion Care

Abortion is currently legal up to the third trimester in Virginia. The circumstances under which abortion is legal are laid out as exceptions to a general criminal prohibition on abortion. For example, in the first trimester, abortions can be performed by licensed physicians or advanced practice registered nurses; in the second trimester, abortions can be performed only by licensed physicians.

Virginia eliminated several provisions through the Reproductive Health Protection Act of 2020, such as an ultrasound requirement and a mandatory 24-hour waiting period. However, the historical legacy of some provisions, the continued presence of abortion in the criminal code, the highly restricted availability of state-based for abortion services, and consent and notification requirements for unemancipated minors create a varied environment for the provision of abortion care in the state.

Some local jurisdictions have tried to restrict abortions through legislation and litigation, such as a landlord trying to rescind an abortion provider's lease in Bristol (Kilo Delta, LLC v. Bristol Women's Health PLLC, an ongoing lawsuit) or an attempt to restrict mailing abortion medication in Grayson County, which was not successful. In general, respondents' ability or willingness to try to open new clinics or move locations often varied by county based on zoning restrictions or other local actions.

Policies on gestational age often differed by facility type, with many clinics reporting additional gestational age limits, particularly in recent years. Limits tended to vary depending on institutional definitions of viability and the comfort levels and ability of physicians, as well as the ability to transfer patients (typically those more medically complex or in need of emergency care) to a nearby hospital. There were also reported variations in sedation policies for different clinic types.

Unclear language in the Code of Virginia, as well as zoning restrictions and other local and institutional actions restricting building use, affected the physical setting where abortion care could be offered. For example, some respondents found the continued presence of language around a state-licensed hospital in Virginia’s code for second-trimester care to mean that their clinics could not provide care outside the first trimester. In addition, respondents looking to open a new clinic or potentially change clinic locations spoke to the impact of local zoning policies and other actions that often made it more difficult to find a space to provide care.

Many clinicians reported no or minimal impact of Virginia policies on their ability to provide abortion care. This effect was often expressed in relation to policies in nearby states with more-restrictive policies. For those respondents who did report an impact, they spoke primarily to seeing increasingly complex cases, particularly at later gestational ages. Respondents also pointed to the ability for advanced practice registered nurses to be able to provide abortion care in the first trimester as facilitating access to those seeking abortion care in the state.

Interview participants emphasized the disproportionate negative impact that Virginia policies have on unemancipated minors, particularly with the notarized form requirement for parental consent (or the need for judicial bypass). In addition, respondents shared that patients who may be undocumented or underemployed could be more vulnerable to access issues given the general lack of coverage from state-based Medicaid. However, on the whole, many respondents thought that abortion care in Virginia is largely accessible, particularly because there are no mandatory waiting periods and no specific consent requirements (for adults), and people in Virginia can receive medication abortions through telehealth.