Anti-Abortion Laws: A Decade Of Growing Restrictions

Abortion laws in the United States have changed significantly since the Supreme Court overturned Roe v. Wade in June 2022. The ruling removed federal protection for abortion access, allowing individual states to impose their own regulations. As a result, 14 states have banned abortion, while others have tightened restrictions on the procedure.

The new laws vary in their specifics, but most include exceptions for the life of the mother, and some include exceptions for rape, incest, fetal anomalies, or the mother's health. In some states, abortions are banned after a certain number of weeks, typically six, while other states have banned abortion at any stage of pregnancy.

Gestational limits on abortions

Gestational limits refer to the point within a pregnancy when a termination is permissible. These limits vary depending on the legal framework, including the circumstances under which abortion is allowed.

In countries allowing abortion on request, the most common gestational limit is 12 weeks. However, these countries often allow abortions under a range of circumstances after this limit has expired. Countries with restrictive abortion laws, such as those that only permit abortion when the woman's life or health is at risk, typically do not prescribe a gestational limit.

The World Health Organization (WHO) acknowledges that efforts to impose gestational limits on abortion may have negative consequences for women whose pregnancies have exceeded these limits. WHO emphasizes that abortion to save a woman's life or minimize risk to her health may be necessary at any point during pregnancy.

Gestational limits vary significantly across the globe, particularly in relation to the circumstances under which abortion is legal. While the most common gestational limit for abortion on request is 12 weeks, the shortest gestational limit for abortion on request is 8 weeks, and a handful of countries do not set a legal gestational limit.

In the United States, abortion laws vary widely from state to state. Since the overturning of Roe v. Wade in 2022, individual states have been allowed to regulate any aspect of abortion not preempted by federal law. Currently, 13 states have criminal penalties for performing abortions, regardless of gestational age.

In terms of gestational limits, the United States is one of eight countries that allows elective abortion with no federal gestational limit. However, U.S. federal law does not place any gestational limits on abortion, and 29 states permit elective abortion past 15 weeks of gestation.

The abortion debate often centers around the induced abortion of a pregnancy, also known as "elective abortion" or "voluntary abortion," which refers to the interruption of pregnancy before viability at the request of the woman but not for medical reasons. After viability, doctors refer to an induced miscarriage as a "termination of pregnancy."

Ultrasound requirements

As of September 1, 2023, 13 states require verbal counseling or written materials to include information on accessing ultrasound services. 27 states regulate the provision of ultrasound by abortion providers. 6 states mandate that an abortion provider perform an ultrasound on each person seeking an abortion and require the provider to show and describe the image. 10 states mandate that an abortion provider perform an ultrasound on each person seeking an abortion, and 8 of these require the provider to offer the patient the opportunity to view the image. 8 states require that a patient be provided with the opportunity to view an ultrasound image if their provider performs the procedure as part of preparation for an abortion. 6 states require that a patient be provided with the opportunity to view an ultrasound image.

Arguments Against Ultrasound Requirements

Arguments For Ultrasound Requirements

Ultrasound, either abdominal or transvaginal, is common practice to assure appropriate dating of the pregnancy. Ultrasound viewing may be beneficial to patients who are uncertain about their decision to have an abortion. A recent study of patients at a large urban US abortion center found that 42.6% of women desired to view their ultrasounds.

Waiting periods

The World Health Organization (WHO) has recognised that waiting periods "demean women as competent decision-makers". Reflecting this, the WHO recommends against waiting periods. International human rights bodies have similarly encouraged states to repeal and not to introduce waiting periods, which they recognise as operating as barriers to accessing sexual and reproductive healthcare.

Counselling requirements

In the United States, abortion is a highly divisive issue, with laws varying from state to state. Since 2010, there has been a wave of anti-abortion legislation, with 13 states passing so-called "trigger laws" that effectively ban abortions in the event that Roe v. Wade was overturned. In June 2022, the U.S. Supreme Court did indeed overturn Roe v. Wade, allowing states to ban abortion outright. As of October 2024, 14 states have made abortion illegal.

In this context, counselling requirements for abortions have come under scrutiny. Counselling requirements are based on the long-standing tradition of informed consent, which holds that patients must possess the capacity to make decisions about their care, that their participation in these decisions must be voluntary, and that they must be provided with adequate and appropriate information. However, abortion counselling requirements sometimes conflict with these principles by mandating the provision of irrelevant or misleading information.

As of August 2023, 33 states required patients to receive counselling before an abortion, with 29 of these states detailing the specific information that providers must give, and 4 states having abortion-specific requirements that follow the principles of informed consent. 28 of these states also required patients to wait at least 24 hours between counselling and the abortion procedure. 16 states required in-person counselling, necessitating two separate trips to the facility.

The information provided during counselling varies from state to state, but nearly all states that require counselling include information about the abortion procedure and fetal development. Many states also require information on the gestational age of the fetus, fetal development throughout pregnancy, the ability of a fetus to feel pain, the potential health risks of abortion and continuing a pregnancy, and the potential effect of abortion on future fertility.

In addition to these requirements, several states mandate the provision of medically inaccurate or misleading information. For example, 8 states require counsellors to inform patients that a medication abortion can be stopped after the first dose of pills, and 5 states require counsellors to assert a link between abortion and an increased risk of breast cancer, despite a lack of scientific evidence.

While counselling requirements are intended to ensure informed consent, critics argue that they can create unnecessary barriers and hardships for patients seeking abortions, particularly those who have to travel long distances or make multiple trips to access care.

Telehealth restrictions

Telehealth services have been vital in helping people access abortion pills, especially in states where abortion is banned. In the US, abortion pills are now used in the majority of abortions. In 2021, the FDA made abortion pills easier to obtain by removing the long-standing requirement to prescribe mifepristone in person. This meant that abortion pills could be prescribed via telehealth services and delivered by mail.

Telehealth abortion services are often provided by virtual clinics, which offer synchronous (video) or asynchronous (secure text messaging) communication with patients. Synchronous models require strong internet connectivity, while asynchronous models can be accessed using more types of devices and may be more private and convenient for the patient.

A study by the University of California, San Francisco, found that telehealth medication abortion is effective and safe, with a 98% effectiveness rate. This is similar to the effectiveness rate for in-person medication abortion care. The study also found that synchronous and asynchronous telehealth abortion services had similar effectiveness and safety rates.

However, access to abortion pills is under threat. In April 2023, a federal court ruling reversed the FDA's approval of mifepristone. This ruling was issued despite evidence demonstrating the effectiveness and safety of the drug. In addition, some states have laws that prohibit telehealth abortion.

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