By Rose Hoban
In a confirmation of the rumors that had been swirling in the halls of the General Assembly in recent weeks, legislators from the House of Representatives filed a bill Wednesday that could make obtaining an abortion in North Carolina more cumbersome.
House Bill 465 would compel women to wait 72 hours before obtaining an abortion, up from the current 24-hour waiting period; limit the provisioning of abortions to OB/GYNs; and restrict the medical schools at UNC-Chapel Hill and East Carolina from performing or supervising an abortion.
The bill would also require physicians performing the procedure after 16 weeks gestation to submit to the state Department of Health and Human Services ultrasound images and clinical impressions. For procedures done after 20 weeks, they would be required to submit images, clinical justification for the procedure and an analysis of how continuing the pregnancy would have endangered the life of the mother.
“We want to make sure that [providers] are basically doing what they’re supposed to be doing under statute,” said Rep. Jacqueline Schaffer (R-Charlotte), one of the bill’s primary sponsors.
“The [Department of Health and Human Services] is overseeing these clinics and the regulation of these clinics and we want to make sure that the things that are going on under their purview are being done correctly and in accordance with the law.”
Providers and advocates for reproductive rights say the bill is an attempt to restrict the ability of women to have an abortion and to intimidate doctors.
The wait
Twenty-six states in the U.S. have waiting times before a woman can obtain an abortion, according to the Guttmacher Institute, a not-for-profit organization that does research in reproductive health. Currently, only three of those states – Utah, South Dakota and Missouri – require women to wait 72 hours before they can have the procedure.
“We want to ensure that women have all the information that they need to make this kind of decision,” Schaffer said. “This is a big decision; it’s a life decision and it’s important for them to have all the facts, and we want to make sure they have that.”
But reproductive rights advocates such as David Grimes said the wait was “clearly a punitive measure.”
Grimes, a retired professor of obstetrics at UNC-Chapel Hill, said there’s no rationale for the waiting period.
“It will only add to the expense for everyone concerned, patients and physicians. Like if women have to arrange child care, spend extra time in town, that burdens women unnecessarily,” he said. “It’s there to punish women and their clinicians.”
Schaffer argued that the law allows for women to give consent over the telephone and that having a three-day wait would not burden them at all.
Her bill co-sponsor, Rep. Pat McElrath (R-Emerald Isle), seemed to contradict that statement.
“The 24-hour wait has not impeded any abortions. It’s actually saved a lot of lives: about 2,500 to 3,000 a year has been calculated,” she said. “We thought giving a woman an extra 48 hours to look at the other alternatives to abortion … probably would be a very good thing.”
Data show that the number of abortions in North Carolina dropped from 22,370 in 2011 to 19,818 in 2013 (the latest year for which complete data are available). Abortion opponents have pointed to that drop as evidence of the success of measures to restrict access to abortion. But researchers from Guttmacher and others say that nationwide abortion rates are dropping alongside rates of birth, even in states without waiting periods and other measures that might restrict access.
Who’s allowed?
The bill would restrict the ability of all but obstetrician/gynecologists to perform abortions, removing the ability of family physicians to do the procedures.
“It’s not unusual in rural areas for abortion providers to be family physicians,” said Narges Farahi, a family physician who practices in Chapel Hill.
Farahi explained that when she was trained during her residency, she learned skills to provide abortions and post-abortion care alongside OB/GYNs.
“You don’t need specialized training to work with a uterus,” she said. “Family doctors have lots of experience with taking care of women who are pregnant. They have a requirement to learn obstetrics and to learn women’s health and outpatient gynecological procedures.”
Farahi also said there’s no medical or research literature showing that family physicians are not able to provide abortion care safely.
Schaffer and McElrath said the provisions in the bill were there to make abortions safer.
But Chapel Hill obstetrician Amy Bryant disagreed. She recounted a story from her time in training of a woman from a rural community whose fetus had died in utero. The woman had started to show signs of a serious infection after she couldn’t get care. By the time she reached UNC, the woman was beyond help and she died.
“She was 21 and a mother of two,” Bryant said. “I’ll never forget it. It was the most devastating thing that’s happened in my whole career.”
Docs targeted
The bill would also restrict all abortions from being performed at the hospitals that house the two schools of medicine that receive state dollars, something that concerns Grimes.
“Abortion care is part of an obstetrician’s training, absolutely,” he said. “The American College of Obstetricians and Gynecologists has said this and the association of professors and the council of resident education have also said the same thing. It’s a fundamental part of training.”
Much of what physicians do in the aftermath of a miscarriage – known as “spontaneous abortion” in medical terms – and in induced abortions is similar.
Grimes also said new residents need to know these basic procedures and that the move could reduce the prestige of the UNC program. He said the material is part of the board certification for residents in obstetrics and gynecology.
But McElrath argued that medical residents could either leave UNC or ECU to get trained in the procedure or could read didactic material to learn what they need to know.
Both sponsors said that about 400 abortions had been performed at UNC and ECU in the past year, something they said violated the state’s law against taxpayer-funded abortions.
“Our citizens do not want state funds to be used for abortion,” McElrath said. “They’ve made it loud and clear. And that’s what this is doing, is preventing it.”
The bill’s requirement that physicians report their clinical rationale for abortions done after 16 weeks could have a chilling effect, said the physicians interviewed for this story.
In North Carolina, in 2013, only about 2.5 percent of abortions occurred after 16 weeks gestation and only 0.3 percent occurred after 20 weeks, a total of 55.
Bryant pointed out that there’s no provision in the bill for dealing with fetal anomalies found later in pregnancy. She said the additional wait time could push the time for pregnancy termination beyond the 20-week mark.
“Fetal anomalies are usually diagnosed quite late: between 19 and 20 weeks of pregnancy” Bryant said. “It has to do with the best time to see the anatomy of the fetus; you can’t see it optimally earlier in the pregnancy.”
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