Analysis Law and Policy

States Enact Record Number of Abortion Restrictions in First Half of 2011

Rachel Gold and Elizabeth Nash

In the first six months of 2011, states enacted 162 new provisions related to reproductive health and rights.

In the first six months of 2011, states enacted 162 new provisions related to reproductive health and rights. Fully 49 percent of these new laws seek to restrict access to abortion services, a sharp increase from 2010, when 26 percent of new laws restricted abortion. The 80 abortion restrictions enacted this year are more than double the previous record of 34 abortion restrictions enacted in 2005—and more than triple the 23 enacted in 2010. All of these new provisions were enacted in just 19 states.

A Mix of Old and New Strategies to Curb Access to Abortion Care

Counseling and waiting periods. Five states (IN, KS, ND, SD and TX) adopted laws related to abortion counseling and waiting periods in 2011, but a measure adopted by South Dakota at the end of March went significantly farther than those approved in other states. The law expands the pre-abortion waiting period to 72 hours, requires the woman to visit a crisis pregnancy center in the interim and mandates that abortion counseling be provided in-person by the physician who will perform the procedure. The counseling must include information on all known risk factors related to abortion, even when the information is not supported by mainstream medical opinion and is methodologically unsound. The law is currently not in effect, pending the outcome of a legal challenge.

Gestational bans. Legislators in 15 states introduced measures based on a law adopted in Nebraska last year. The provision bans abortions at and after 20 weeks’ gestation, based on the spurious assumption that a fetus can feel pain at that point. Under the measure, abortions may be performed after 20 weeks only if the woman’s life is endangered or if there is a risk of “substantial and irreversible physical impairment of a major bodily function.” So far this year, similar measures have been adopted in five states (AL, ID, IN, KS and OK; see State Policies on Later Term Abortion). These laws appear to conflict with Supreme Court rulings barring states from placing an undue burden on women seeking an abortion prior to viability, a point that occurs well past 20 weeks.

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Heartbeat” bill. Ohio is taking a different approach to achieve the same goal of banning abortion. In June, the House adopted a measure that would ban abortion once a fetal heartbeat can be detected, which usually occurs between six and 10 weeks’ gestation. The bill is awaiting action in the Senate.

Banning abortion coverage in new insurance exchanges. With plans for the implementation of health care reform underway in most states, the issue of insurance coverage for abortion was considered in 24 states, and restrictions were enacted in eight. In four states (KS, NE, OK and UT), the new laws restrict abortion coverage under all private health insurance plans. These restrictions will apply to coverage that will be available through the health exchanges being set up, as will new measures enacted in four other states (FL, ID, IN and VA). Including these new laws, eight states now restrict abortion coverage that is offered in any private health plan (including coverage through an exchange), and six others have restrictions that apply only to coverage through health exchanges (see Restricting Insurance Coverage of Abortion).

Medication abortion. Legislatures devoted significant attention to medication abortion for the first time during the 2011 session; measures were introduced in 14 states and enacted in six. Medication abortion has become an integral part of abortion care, now accounting for 17 percent of procedures provided in nonhospital clinics. Lawmakers considered two types of restrictions related to medication abortion:

  • Laws enacted this year in Kansas and Oklahoma require abortion providers to use a protocol that was specified by the FDA when the method was approved in 2000. This protocol has since been supplanted by a new one that, based on a substantial body of evidence, supports a more streamlined procedure under which women are given a lower dose of the medication and allowed to take the second dose at home, eliminating a second visit to the abortion provider. The new protocol also allows use of medication abortion up to 63 days’ gestation, rather than the 49 days permitted under the FDA protocol. A similar restriction that was enacted by Ohio in 2004 was recently upheld in federal court.

  • In an entirely new approach to restricting access to abortion, five states (AZ, KS, ND, NE and TN) banned the use of telemedicine for the provision of medication abortion, a procedure through which a woman can go to an abortion provider, receive counseling via videoconference from a physician in another location who then authorizes on-site staff to dispense the medication. Use of telemedicine in general has been growing rapidly in recent years, and is widely credited with expanding access to medical care in areas, especially rural communities, where services have often been inaccessible.

Family Planning Programs in the Crosshairs

For the first time in recent memory, state legislatures devoted significant attention to issues related to family planning in 2011. Much of this came in the context of state budget bills.

Holding the line in some states. Considering the historic fiscal crises facing many states, it is significant that family planning escaped major reductions in nine of the 18 states (CO, CT, DE, IL, KS, MA, ME, NY and PA) where the budget has a specific line item for family planning.

Deep cuts in others. The story, however, was different in the remaining nine states. In six (FL, GA, MI, MN, WA and WI), family planning programs sustained deep cuts, although generally in line with decreases adopted for other health programs. In the other three states, however, the cuts to family planning funding were disproportionately large: Montana eliminated the family planning line item, and New Hampshire and Texas cut funding by 57 percent and 66 percent, respectively.

Expanding Medicaid eligibility. It is especially noteworthy in this fiscal climate that two states moved to expand Medicaid eligibility for family planning. In Maryland, the legislature directed the state to extend coverage to individuals with an income up to 200 percent of the federal poverty level; the state currently has a limited expansion that extends coverage only to women following a Medicaid-funded delivery. The state received approval for this change from the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, at the end of June, and the expansion is expected to go into effect in January 2012. Washington State dramatically reversed earlier attempts to roll back its existing Medicaid family planning expansion entirely. The legislature directed the state to raise eligibility under the program from 200 percent to 250 percent of the federal poverty level.

Targeting providers. Nonetheless, five states moved to restrict funding to family planning providers, largely paralleling similar attempts made in Congress earlier in the year. These states took three distinct approaches:

  • Two states moved to restrict eligibility for family planning funds for providers that have any association with abortion. Indiana prohibits agencies that provide abortion from receiving any funding through the state, including Medicaid. (On June 30, a federal district court blocked enforcement of the legislation pending resolution of a legal challenge filed by the state’s Planned Parenthood affiliate.) Wisconsin prohibits agencies that provide abortion services or referrals from receiving funding through the state. Neither state is a Title X grantee, so Title X funds are not affected by the restriction. Planned Parenthood is the only agency that is affected in either state. These new measures join long-standing provisions in three other states (CO, OH and TX) requiring agencies that receive funding—either state family planning funds or federal block grant allotments—through a state agency to be separate from agencies that provide abortion services (see State Family Planning Funding Restrictions).

  • North Carolina adopted a measure that explicitly bans Planned Parenthood from obtaining funding, including Medicaid, through the state. Since North Carolina is a Title X grantee, the measure blocks Planned Parenthood affiliates in the state from receiving Title X funds. (Planned Parenthood of Central North Carolina has filed a lawsuit challenging the constitutionality of this provision; as of this writing, the measure remains in effect.)

  • Two additional states took aim at agencies that provide mostly family planning services, regardless of whether they have any connection to abortion. Kansas enacted a measure that limits the distribution of Title X funds to health departments, hospitals and community health centers; other types of family planning providers are not eligible. (Planned Parenthood of Kansas and Mid-Missouri has filed a legal challenge to the provision; as of this writing, the measure remains in effect.) Texas, meanwhile, adopted a measure that gives priority to health departments, community health centers and hospitals in the distribution of family planning funds, including Title X funds; other family planning providers may receive funding should any remain.

The 2011 state legislative season is rapidly drawing to a close, with only 10 state legislatures remaining in session. Additional states are likely to adjourn in the coming weeks.

For more information:

Guttmacher State Center

Chart of laws enacted in 2011

State Policies in Brief

Guttmacher’s video on “Abortion in the United States”

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (R-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

Analysis Law and Policy

Indiana Court of Appeals Tosses Patel Feticide Conviction, Still Defers to Junk Science

Jessica Mason Pieklo

The Indiana Court of Appeals ruled patients cannot be prosecuted for self-inducing an abortion under the feticide statute, but left open the possibility other criminal charges could apply.

The Indiana Court of Appeals on Friday vacated the feticide conviction of Purvi Patel, an Indiana woman who faced 20 years in prison for what state attorneys argued was a self-induced abortion. The good news is the court decided Patel and others in the state could not be charged and convicted for feticide after experiencing failed pregnancies. The bad news is that the court still deferred to junk science at trial that claimed Patel’s fetus was on the cusp of viability and had taken a breath outside the womb, and largely upheld Patel’s conviction of felony neglect of a dependent. This leaves the door open for similar prosecutions in the state in the future.

As Rewire previously reported, “In July 2013 … Purvi Patel sought treatment at a hospital emergency room for heavy vaginal bleeding, telling doctors she’d had a miscarriage. That set off a chain of events, which eventually led to a jury convicting Patel of one count of feticide and one count of felony neglect of a dependent in February 2015.”

To charge Patel with feticide under Indiana’s law, the state at trial was required to prove she “knowingly or intentionally” terminated her pregnancy “with an intention other than to produce a live birth or to remove a dead fetus.”

According to the Indiana Court of Appeals, attorneys for the State of Indiana failed to show the legislature had originally passed the feticide statute with the intention of criminally charging patients like Patel for terminating their own pregnancies. Patel’s case, the court said, marked an “abrupt departure” from the normal course of prosecutions under the statute.

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“This is the first case that we are aware of in which the State has used the feticide statute to prosecute a pregnant woman (or anyone else) for performing an illegal abortion, as that term is commonly understood,” the decision reads. “[T]he wording of the statute as a whole indicate[s] that the legislature intended for any criminal liability to be imposed on medical personnel, not on women who perform their own abortions,” the court continued.

“[W]e conclude that the legislature never intended the feticide statute to apply to pregnant women in the first place,” it said.

This is an important holding, because Patel was not actually the first woman Indiana prosecutors tried to jail for a failed pregnancy outcome. In 2011, state prosecutors brought an attempted feticide charge against Bei Bei Shuai, a pregnant Chinese woman suffering from depression who tried to commit suicide. She survived, but the fetus did not.

Shuai was held in prison for a year until a plea agreement was reached in her case.

The Indiana Court of Appeals did not throw out Patel’s conviction entirely, though. Instead, it vacated Patel’s second charge of Class A felony conviction of neglect of a dependent, ruling Patel should have been charged and convicted of a lower Class D felony. The court remanded the case back to the trial court with instructions to enter judgment against Patel for conviction of a Class D felony neglect of a dependent, and to re-sentence Patel accordingly to that drop in classification.

A Class D felony conviction in Indiana carries with it a sentence of six months to three years.

To support Patel’s second charge of felony neglect at trial, prosecutors needed to show that Patel took abortifacients; that she delivered a viable fetus; that said viable fetus was, in fact, born alive; and that Patel abandoned the fetus. According to the Indiana Court of Appeals, the state got close, but not all the way, to meeting this burden.

According to the Indiana Court of Appeals, the state had presented enough evidence to establish “that the baby took at least one breath and that its heart was beating after delivery and continued to beat until all of its blood had drained out of its body.”

Therefore, the Court of Appeals concluded, it was reasonable for the jury to infer that Patel knowingly neglected the fetus after delivery by failing to provide medical care after its birth. The remaining question, according to the court, was what degree of a felony Patel should have been charged with and convicted of.

That is where the State of Indiana fell short on its neglect of a dependent conviction, the court said. Attorneys had failed to sufficiently show that any medical care Patel could have provided would have resulted in the fetus surviving after birth. Without that evidence, the Indiana Court of Appeals concluded, state attorneys could not support a Class A conviction. The evidence they presented, though, could support a Class D felony conviction, the court said.

In other words, the Indiana Court of Appeals told prosecutors in the state, make sure your medical experts offer more specific testimony next time you bring a charge like the one at issue in Patel’s case.

The decision is a mixed win for reproductive rights and justice advocates. The ruling from the court that the feticide statute cannot be used to prosecute patients for terminating their own pregnancy is an important victory, especially in a state that has sought not just to curb access to abortion, but to eradicate family planning and reproductive health services almost entirely. Friday’s decision made it clear to prosecutors that they cannot rely on the state’s feticide statute to punish patients who turn to desperate measures to end their pregnancies. This is a critical pushback against the full-scale erosion of reproductive rights and autonomy in the state.

But the fact remains that at both trial and appeal, the court and jury largely accepted the conclusions of the state’s medical experts that Patel delivered a live baby that, at least for a moment, was capable of survival outside the womb. And that is troubling. The state’s experts offered these conclusions, despite existing contradictions on key points of evidence such as the gestational age of the fetus—and thus if it was viable—and whether or not the fetus displayed evidence of life when it was born.

Patel’s attorneys tried, unsuccessfully, to rebut those conclusions. For example, the state’s medical expert used the “lung float test,” also known as the hydrostatic test, to conclude Patel’s fetus had taken a breath outside the womb. The test, developed in the 17th century, posits that if a fetus’ lungs are removed and placed in a container of liquid and the lungs float, it means the fetus drew at least one breath of air before dying. If the lungs sink, the theory holds, the fetus did not take a breath.

Not surprisingly, medical forensics has advanced since the 17th century, and medical researchers widely question the hydrostatic test’s reliability. Yet this is the only medical evidence the state presented of live birth.

Ultimately, the fact that the jury decided to accept the conclusions of the state’s experts over Patel’s is itself not shocking. Weighing the evidence and coming to a conclusion of guilt or innocence based on that evidence is what juries do. But it does suggest that when women of color are dragged before a court for a failed pregnancy, they will rarely, if ever, get the benefit of the doubt.

The jurors could have just as easily believed the evidence put forward by Patel’s attorneys that gestational age, and thus viability, was in doubt, but they didn’t. The jurors could have just as easily concluded the state’s medical testimony that the fetus took “at least one breath” was not sufficient to support convicting Patel of a felony and sending her to prison for 20 years. But they didn’t.

Why was the State of Indiana so intent on criminally prosecuting Patel, despite the many glaring weaknesses in the case against her? Why were the jurors so willing to take the State of Indiana’s word over Patel’s when presented with those weaknesses? And why did it take them less than five hours to convict her?

Patel was ordered in March to serve 20 years in prison for her conviction. Friday’s decision upends that; Patel now faces a sentence of six months to three years. She’s been in jail serving her 20 year sentence since February 2015 while her appeal moved forward. If there’s real justice in this case, Patel will be released immediately.