Abortion Law In North Carolina: Understanding The Legal Landscape

Abortion laws vary from state to state across the US, and North Carolina is no exception. As of July 1, 2023, abortion in North Carolina is illegal after 12 weeks of pregnancy, with some exceptions. The state's abortion laws have a complex history, with changes being made as recently as 2023. So, what is the current law, and how did it come about?

Abortion after 12 weeks

Abortion laws in North Carolina have been a topic of much debate and discussion in recent years, with several changes taking place. As of July 1, 2023, abortion in North Carolina is illegal after 12 weeks of pregnancy, with some exceptions. This 12-week ban was passed after the state's Republican-controlled General Assembly overrode the Democratic governor's veto. Here is a more detailed overview of the abortion laws in North Carolina, specifically focusing on abortion after 12 weeks:

The 12-week ban, known as Senate Bill 20, prohibits abortion after 12 weeks of pregnancy in most circumstances. However, there are several exceptions to this rule, which allow abortions after 12 weeks in specific cases:

• In cases of rape or incest, abortion is permitted through the 20th week of pregnancy.
• If there is a diagnosis of a "life-limiting" fetal anomaly, abortion is allowed through the 24th week of pregnancy.
• If the pregnant woman's life is in danger or she faces a severe health risk, abortion is permitted at any point during the pregnancy.

Additional Considerations:

It is important to note that abortion providers are required to report all abortions after 12 weeks, but the patient's name or identifying information remains confidential. Additionally, abortions after 12 weeks must be performed in hospitals.

The new abortion restrictions in North Carolina have been met with mixed reactions, with abortion-rights advocates expressing concern about the impact on low-income women and those in rural areas. On the other hand, anti-abortion groups have supported the legislation, considering it a step towards becoming a pro-life state.

Medical emergencies

In North Carolina, abortions are permitted at any stage of pregnancy if a qualified physician determines that there is a medical emergency that places the woman at risk of death or loss of a major bodily function. However, it is important to note that this does not include psychological or mental health emergencies.

The specific requirements and exceptions outlined in the North Carolina Session Law 2023-14 state that abortions are generally legal during the first 12 weeks of pregnancy. After this point, abortions are highly restricted and only permitted in specific circumstances. These circumstances include cases of rape or incest up to the 20th week of pregnancy, detection of a life-limiting fetal anomaly up to the 24th week, and medical emergencies that threaten the life or health of the pregnant woman.

The law also mandates an in-person counseling appointment at least three days before the abortion procedure and a follow-up appointment for medication abortion patients 7 to 14 days after the abortion. This law has been criticized for creating barriers for patients seeking abortions and making it more challenging for both patients and providers to obtain and provide care.

Additionally, it is worth noting that North Carolina's abortion laws have been subject to changes and legal challenges over the years. For instance, in 2019, U.S. District Judge William Osteen formally struck down the state's 'life of the mother only' 20-week abortion ban, pushing the date at which abortions could be performed to a later point in many cases.

Rape and incest

In North Carolina, abortion is illegal after 12 weeks of pregnancy. However, in the case of rape or incest, abortion is legal through the 20th week of pregnancy. The new law, which came into effect on July 1, 2023, does not require survivors of rape or incest to report their experience to law enforcement before seeking an abortion. However, if the abortion is obtained after the 12th week of pregnancy, the survivor must disclose the rape or incest to the physician, who is then required to record certain information and report it to the North Carolina Department of Health and Human Services (NCDHHS).

Rape is defined as "criminally injurious conduct in the nature of" forcible rape, second-degree rape, statutory rape of a child, and statutory rape of a person under 15 years of age. On the other hand, incest refers to "criminally injurious conduct in the nature of" carnal intercourse with a grandparent, grandchild, parent, child, sibling, aunt, uncle, nephew, or niece.

It is important to note that abortion providers in North Carolina are required to report all abortions after 12 weeks, but the survivor's name or identifying information remains confidential. Additionally, the survivor is not obligated to report rape or incest to law enforcement, and the decision to do so is entirely at their discretion.

The new law also imposes specific requirements for informed consent and advance consultation before an abortion can be performed. These requirements include an in-person consultation at least 72 hours before the procedure, specific information that must be conveyed orally and in writing, and the presence of a qualified physician during the procedure.

The debate surrounding rape and incest exceptions in abortion laws is complex and multifaceted. Some argue that the inclusion of these exceptions is a tactic to deflect from the broader implications of abortion restriction, while others emphasize the need for empathy and non-partisanship in considering the trauma experienced by survivors of rape and incest.

Life-limiting foetal anomalies

Making decisions about prenatal and neonatal care when facing a life-limiting foetal condition is an extremely stressful process for parents. Literature on parental decision-making in this context reveals that parents go through a complex, iterative, and progressive decision-making process. Parents consider both objective medical information and their subjective values and priorities.

A study by Denney-Koelsch and Côté-Arsenault (2022) found that parents' decision-making process can be broken down into three phases:

• Identifying the decision to be made: Parents need to understand the diagnosis, testing, and treatment options, as well as the implications for both the mother and the baby.
• Conducting a risk-benefit analysis: This involves weighing objective medical factors, such as diagnostic and prognostic certainty, and subjective factors, such as values, spirituality, impact on self, partner, and other children, and the desire to avoid suffering and regrets.
• Making a decision: Parents aim to reach a decision they can live with and that aligns with their values, ultimately seeking to avoid any regrets.

The decision-making process is further complicated by the involvement of multiple healthcare professionals, including obstetricians, maternal-fetal medicine physicians, neonatologists, genetics counsellors, and palliative care providers. These clinicians often work in siloed teams, which can lead to fragmented care and increase the stress on parents.

To support parents facing life-limiting foetal anomalies, some programs offer perinatal palliative care (PPC). PPC uses an interdisciplinary team approach to address the medical, psychosocial, and spiritual needs of families throughout pregnancy, birth, and death. It also aims to improve communication between parents and the various specialty teams involved.

In conclusion, when faced with a life-limiting foetal anomaly, parents go through a complex and emotionally challenging decision-making process. Healthcare providers play a crucial role in supporting parents by providing clear information, understanding their values, and facilitating shared decision-making.

Parental consent

An exception allows a minor to request a judicial waiver. A judge can grant a waiver when they find any of the following:

• The minor is mature enough to decide the matter without parental consent
• The rule for parental consent is not in the child's best interests
• The pregnancy resulted from rape or incest

If a state has parental involvement laws, a minor may be able to get a judge's permission to have an abortion without telling their parents. This is called a "judicial bypass".

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