Over the past decade, state laws restricting abortion have mostly focused on trying to reduce demand for the service. Some states do this simply by making abortion financially out of reach: The average cost of a first-trimester surgical abortion is $451, and in all but fifteen states Medicaid will not pay for low-income women to have the procedure.

Aside from direct financial barriers, states have passed hundreds of other abortion laws with the intent of driving down demand for the procedure by creating onerous barriers and hassles for women seeking to terminate their pregnancies. Many states require parental approval for teens younger than 18; mandated 24-hour waiting periods between receiving often-inaccurate information about the health and psychological risks of abortion and having the procedure done; requirements that women have sonograms and be forced to view their fetuses, and most recently, a number of states have proposed so-called “fetal heartbeat laws” that throw up yet another ideological barrier to an already fraught decision.

Surprisingly, despite this accumulation of laws, Theodore Joyce, professor of economics at Baruch College and the Graduate Center of CUNY writes in a Perspective piece published this week in the New England Journal of Medicine, “these demand-side policies have had relatively little impact on national abortion rates” which have dropped only about 1% in recent years, for a total of about 1.3 million procedures last year.

It turns out that while teen notification laws, waiting periods and having to listen to ideologically-based “informed consent” scripts might prevent small subsets of women from getting abortions, these laws haven’t had the big impact intended by abortion foes. According to Joyce, most women have already made up their minds for good by the time they enter a clinic.

But there is a new legal tactic that, left unchallenged, could provide a more serious threat to women’s reproductive choice. Increasingly, states are proposing laws that attempt to impact the “supply” side of abortion—by imposing stringent requirements on the dwindling number of providers, they are hoping that many of those remaining will be forced to abandon their practices or clinics.

Joyce points out that a newer set of state regulations might requirethat stand-alone clinics that perform first-trimester abortions meet the standards of an ambulatory surgical center. In Kansas, for example; “The regulations stipulate, among other requirements, that facilities must have procedure rooms of at least 150 [square feet]; each procedure room must have janitorial space of at least 50 [square feet]; facilities must have designated dressing rooms for patients and separate ones for staff; and each dressing room must have a toilet, a washing station, and storage for clothing.” The thrust of these provider regulations is; “let’s make the requirements for certification so onerous that they can’t afford to make the renovations and have to shut down,” Joyce tells me.

According to Kaiser Health News, these new rules could force two of Kansas’ three remaining abortion providers to stop offering the service. (A judge issued an injunction temporarily blocking the new regulations but the battle continues.) Virginia, Arizona and Utah are also implementing similar new restrictions on abortion providers. The Guttmacher Institute estimates that 87% of all U.S. counties lacked an abortion provider in 2008; even though 35% of women live in those counties.

Clinics that offer abortions are now clustered in major cities like New York, Atlanta, Los Angeles and Miami and women who need abortions must often travel hundreds of miles to get them. As new laws force the closure of clinics in smaller cities in the South and Midwest, the end result is that many women may simply be unable to obtain an abortion…legally. Like in the decades before Roe v. Wade, those women who live in states without abortion providers and can afford the time and expense will make journeys averaging 500 miles; those who can’t will be forced to bear children they are unprepared to care for—either financially or emotionally.

Joyce and his colleagues published a more involved paper in a recent issue of the Journal of Policy Analysis (it can be accessed without cost as a working paper ) that provides greater detail on how he and his colleagues arrived at their findings on the comparative impact of “demand side” vs. “supply side” state abortion laws. But one example involves Texas, which enforced the “Women’s Right to Know Act” in 2004 requiring all abortions after 16 weeks to be performed in ambulatory surgical centers. None of the 54 providers in the state met the requirements of a surgical center, causing the number of abortions performed after 16 weeks in Texas to drop 88%. Meanwhile the number of women who went to neighboring states for the procedure almost quadrupled. If “supply side” regulations were to spread across the country, even this access to abortion in nearby states could be seriously curtailed.

The fact is that ever since Roe v. Wade, states have provided the battleground for women’s reproductive choice. Supreme Court decisions over the last couple of decades have allowed state laws to spread that ultimately invade privacy, harass women, and damage the doctor-patient relationship—all under the guise of protecting the health of women and their unborn fetuses.

I don’t agree that stilted scripts, parental notification laws and waiting periods (which due to the use of part-time providers in less urban centers can sometimes amount to five days or more) protect the health of women. Neither do unneeded sonograms or the experience of listening to a fetal heartbeat. Abortions have routinely and safely been performed in doctor’s offices and stand-alone clinics for decades and no sudden rise in adverse effects or safety issue is driving these new demands for higher standards. Why do clinics suddenly need to have 150-square foot surgical centers, ample janitorial closets, changing rooms and all the other bells and whistles called for in the new “supply-side” state laws? Why should abortion providers be forced to meet standards that are higher than those required of doctors who perform colonoscopies—an arguably more invasive procedure—in their offices?

The answer is that the fight over abortion has and always will be strictly ideological.

Attacks on women’s reproductive choice are now coming from many sides at the state and federal levels. The Center for Reproductive Rights has been a consistent—and effective—advocate for safe, legal abortion, filing lawsuits in states around the country to block restrictive legislation. Currently, the center is fighting legal battles in Oklahoma and North Dakota that are trying to outlaw or restrict medical abortion, a drug regimen that has been approved by the World Health Organization and is sanctioned by the American College of Obstetrics and Gynecology.

Meanwhile, conservatives in Congress continue to push to suspend all funding for Planned Parenthood and other so-called Title X family-planning clinics that perform abortions—even though the Hyde Amendment has prevented federal funds from going toward abortion since 1994. Instead, Planned Parenthood and other clinics would stand to lose federal money now used solely to provide vitally important services to millions of lower-income women each year including prenatal care, gynecological wellness visits, contraceptive counseling and cancer screening.

In the end, state laws restricting abortion have, until recently, been focused on targeting women directly—counting on harassment, inconvenience, shame and fear to convince them to continue their unwanted pregnancies. (Mind you, these same states have not focused on preventing pregnancy in the first place by increasing funding for contraception or sex-education that gives young people information about a range of options beyond abstinence.) This effort, ironically, has not been very effective.

With the new emphasis on the supply side, legislators are moving into territory that may be more effective, while at the same time presenting an opportunity for new legal challenges. It’s hard to argue that clinics that perform first-trimester abortions—a procedure that Herbert Hodes, a physician who performs abortions at the Women’s Health Center in Overland Park, KA says is commonly done in 2 minutes or less—need to conform to the stringent standards proposed by that state’s new regulation to protect the health of women. Rather, this new crop of laws seems designed specifically to restrict access to abortion and to directly impinge on the rights of women. It’s an issue that will no doubt end up being a seminal question for the higher courts to decide—the sooner, the better.