Days before senators testified on behalf of a bill to protect women’s health services, the National Partnership for Women and Families released a report detailing just how threatened these services are. Aptly titled “Bad Medicine,” the report focuses on a specific threat to women’s healthcare: laws restricting doctors’ professional discretion and mandating how abortions are performed. Such laws require doctors to choose between adhering to a one-size-fits-all law or doing what they know is best for the individual patient.
The report groups these restrictive laws into four categories: ultrasound requirements, biased counseling, mandatory delays and medication abortion restrictions. In states with ultrasound laws, doctors are required to perform ultrasounds on patients seeking abortions, regardless of whether they are desired or even medically necessary. These laws blatantly contradict the American Medical Association Code of Ethics, which clearly states that doctors “should not provide, prescribe or seek compensation for medical services that they know are unnecessary.”
Despite this, 24 states currently have laws requiring doctors to take some action regarding ultrasounds before an abortion. Under the least restrictive of the laws, doctors are required to provide patients with information on how to obtain an ultrasound. Under the most extreme laws, 13 states actually force doctors to perform ultrasounds on all patients seeking abortions, and five of these states require the physicians to display and describe the image to the patient. Even worse, five states require that the abortion procedure be delayed until 24 hours after the ultrasound is performed, delaying a time-sensitive procedure without a medical reason.
Indeed, 30 states have instituted some type of mandatory delay, usually between one and three days, before an abortion can be performed. Eleven states require that women make an additional counseling appointment before receiving an abortion, despite the fact that almost 90 percent of women are highly confident in their decision to get an abortion without the help of counseling.
Mandatory delays and counseling appointments deter women who live far away from clinics from using their services. For those who must travel to get to a clinic, every delay is another day they have to take off of work and be away from family. According to a study by the Texas Policy Evaluation Project, of 300 women seeking abortions in Texas, women incurred an average of $146 in extra costs because of the state’s 24-hour waiting period. Nearly one-third of the respondents said the waiting period had negatively affected their emotional well-being.
In addition to those states that force women into counseling appointments, 28 states require doctors to provide state-supplied—and often incorrect—counseling materials. Among the false information that doctors are required to provide is the unfounded claim that fetuses can feel pain, as well as inaccurate information on the impact of abortion on fertility and the associated risks of breast cancer and suicide. By requiring doctors to provide false or irrelevant information, the state compromises the trust between doctor and patient. And, according to U.S. District Court Judge Catherine Eagles, they also infringe on doctors’ freedom of speech. Striking down a North Carolina ultrasound law that required doctors to provide a state-developed anti-abortion message, Eagles wrote:
The Supreme Court has never held that a state has the power to compel a health-care provider to speak, in his or her own voice, the state’s ideological message in favor of carrying a pregnancy to term, and this Court declines to do so today.
Laws across the country also restrict doctors’ ability to prescribe medication abortions (administered via oral medication rather than invasive surgery). Although studies have shown medication abortions to be safe and effective, 18 states have laws making it more difficult for doctors to carry them out. Five states require doctors to administer medication abortions following the exact procedure listed on the outdated FDA label, instead of following current medical standards. This requirement reduces the number of weeks in which a medication abortion is possible and tacks on an unnecessary doctor’s visit to administer the final dosage. Interestingly, doctors can administer other medications “off-label” in almost any other circumstance. In fact, one out of every five prescriptions is written for off-label use, according to the Agency for Healthcare Research and Quality.
Medication abortions are especially important because the doctor-patient conversation can occur via electronic communication (telephone, web chat, etc.) This practice, commonly known as telemedicine, eliminates much of the time and travel burden associated with abortion services, making them more accessible and financially viable. Studies show that in-person medication abortions and those administered by telemedicine are equally effective and result in equal patient satisfaction. Yet telemedicine, a widely accepted form of health care in most other arenas, is outlawed in 17 states in the case of abortion.
Of these four types of abortion restrictions, 33 states have at least one and 16 states have all four. These laws require physicians to act according to state ideologies, not scientific evidence, and prevent women from getting safe and effective health care. More importantly, they obscure the fact that reproductive health care should be treated like any other form of health care: an issue for the patient and her doctor, not for politicians.
Illustration of doctor courtesy of Flickr user Truthout.org