The growing momentum among state legislators to enact ultrasound “requirements” for abortion is an interesting tactic. Currently 20 states regulate the provision of ultrasound by abortion providers. The point appears to be twofold:
- raise the cost of the procedure to reduce the number of women who can afford an abortion
- require/offer/describe a view of the fetus to dissuade/shame pregnant women into not having the procedure
It’s interesting to me that on both sides there has been very little discussion of the medical evidence. So that’s what I’m going to do.
Issue #1: Cost
Let’s just take that off the table. Every second trimester abortion needs an ultrasound and often gets more than one. Second-trimester abortions are more often done for birth defects, typically diagnosed or confirmed by ultrasound (sometimes a few ultrasounds are done). In addition, these procedures require more skill the further along, so it is essential the practitioner knows the gestational age with as much accuracy as possible. Ultrasound laws will not change any procedure costs for 2nd trimester ultrasounds, but they may affect the viewing requirements (whether the woman sees/hears a description of the ultrasound). I’ll get to that in just a bit.
Many providers already do a 1rst trimester ultrasound, especially with medical abortion. This is because a medical abortion can only be done up to 63 days (9 weeks). However, there is a growing body of literature suggesting medical abortion can safety be accomplished without an ultrasound for 98% of women. So these laws will prevent practitioners from doing away with an ultrasound (i.e. prevent them from practicing evidence based medicine) which will halt efforts to expand medical abortion into low resource settings. Ultrasound requirements will also affect many women getting a surgical procedure as and ultrasound is typically not required if the size of the uterus agrees with the dating of the pregnancy (although some providers do ultrasounds anyway, generally for medico-legal reasons).
So regarding cost, ultrasound requirements may affect a lot of women seeking a 1rst trimester abortion.
Does this accomplish anything? (Which you might want to know if you are going to spend tax payer money enacting a law). No. In fact, studies tell us that both cost and local availability of a provider has no effect on the decision to get an abortion, it simply delays the procedure while the woman figures out her resources. It is insulting to insinuate that a woman has an abortion out of convenience or cost. In Canada, where abortion is free and unencumbered by ill-informed politicians, the rate of abortion is lower than in the United States. It is sex education and widespread access to medical care and contraception that reduces abortion, not laws.
Issue #2: Viewing the image to dissuade a woman from having an abortion
A 2009 study looked at whether viewing an ultrasound image pre-abortion was something women wanted and whether it had an impact on her choice to have the procedure or her emotional experience(1). When given the option, almost 73% of women chose to view their ultrasound image and of those who did, 85% felt it was a positive experience. Not one woman changed her mind about having the abortion after viewing the image. Ten women were selected for an in-depth interview on the subject and all felt that women should be given the choice about viewing their image.
So in fact, states that require a provider to offer a view of the image to the patient are following evidence-based recommendations. Requiring a patient view the image, such as in Texas, is another matter.
We know that cost and laws do not affect the abortion rate. We also know that long acting reversible contraception lowers the abortion rate. There are some excellent studies that tell us that when women get depo-provera or an IUD post-abortion they are far less likely to have a subsequent unplanned pregnancy. But interestingly, many in the anti-choice movement also discourage birth control. If they were really pro-life (i.e. wanting to prevent every abortion possible) they would be handing out contraceptives instead of picketing clinics and clamoring for laws that restrict tobacco, as cigarettes are responsible for the deaths of 5-7% of all premature babies and cause 23-31% of SIDS).
Laws that increase barriers to abortion create hardships for the women seeking the procedure but they do nothing to lower the abortion rate. To focus on abortion restrictions and not contraception is the height of hypocrisy and a waste of taxpayer dollars, because the laws will inevitably get challenged and held up in court, as we have seen in South Carolina and Oklahoma.
Sigh. (See my recent piece, What if all the money spent fighting about abortion…).
There is no medical evidence to support ultrasound laws. They are a waste of taxpayer dollars and do nothing to accomplish the goal of reducing abortion. They also create a dangerous precedent of allowing hypocritical politicians to set unacceptably low standards of medical care based on political goals, religion, and misogyny.
Smaller government indeed.
1) Kulier R, Kapp N. Comprehensive analysis of the use of pre-procedure ultrasound for first- and second-trimester abortion. Contraception 2011;83:30-33.