News Abortion

Utah Legisalators Think 72-Hour Wait Necessary To “Think About What You Are Doing”

Robin Marty

Next, they intend to pass a law sending women to their rooms without dinner.

Utah Governor Gary Herbert recently signed into law the country’s second 72-hour mandatory wait period prior to obtaining an abortion. The law is believed to be highly unconstitutional, placing an undue burden on women attempting to terminate a pregnancy in the first trimester, and is likely to be challenged immediately in court.

But that doesn’t seem to matter much to bill supporters who think these young ladies need to be taught a lesson.

In case it wasn’t abundantly clear that mandatory wait periods are designed to chastise and punish women who chose to terminate pregnancies, the paternalistic statement of the spokesman from a conservative think tank that supports the bill makes it even more obvious.

“An abortion is a decision that can have lifelong impact on a woman and her family,” said [policy analyst Matt] Piccolo. “Given the emotional, physical and psychological impacts on a woman who has an abortion, we think it is reasonable to have waiting period so she can fully understand and think about the consequences of that choice.”

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Think about the consequences of her choice? Will they send her to her room, or just make her sit in the corner while she thinks about it?

News Abortion

Why You Won’t Hear About Abortion From Arizona’s Largest OB-GYN Network

Nicole Knight Shine

MomDoc imposes a virtual gag order on employees when it comes to abortion care, as a half-dozen former OB-GYNs, nurse practitioners, and support staff told Rewire in a series of interviews.

The voice on the other end of the phone is friendly, but unhelpful, when a Rewire reporter says she’s six weeks pregnant and would like an abortion.

“We don’t provide that,” Marie says.

Marie makes appointments for MomDoc, Arizona’s largest women’s health network. MomDoc is owned and run by Mormons who ascribe to a belief that opposes abortion in nearly all cases.

“Can you tell me where I can get an abortion?” the reporter asks.

Marie says she can’t. “I’m sorry,” she adds.

MomDoc imposes a virtual gag order on employees when it comes to abortion care, as a half-dozen former OB-GYNs, nurse practitioners, and support staff told Rewire in a series of recent interviews by phone and email. What they described affords a window into the workings of a private medical practice, one that opposes abortion care and attempts to suppress abortion access on religious grounds.

What MomDoc represents is a real-life test case pitting the power of religious beliefs against the provision of basic health information about a procedure that, according to the Guttmacher Institute, 30 percent of all U.S. women will have before age 45.

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It’s good business to oppose abortion in the sprawling Phoenix basin, home to the largest concentration of Mormons outside of Utah, according to the most recent U.S. Religion Census.

MomDoc CEO Nick Goodman didn’t respond to repeated requests for interviews and comment.

Started in 1976 by two Mormon OB-GYNs, MomDoc has 21 offices that operate under various names, such as Goodman & Partridge, MomDoc Midwives, MomDoc Women for Women, and Mi Doctora. MomDoc health-care centers offer reproductive services like birth control, and accept Medicaid patients, which means MomDoc is paid with federal dollars.

That Arizona’s largest OB-GYN practice opposes abortion care disturbs pro-choice advocates in a state where reproductive health access is constricted by forced waiting periods, parental consent requirements, and state-directed counseling intended to discourage patients.

Ethical guidelines from the American Congress of Obstetricians and Gynecologists (ACOG), a professional organization of 57,000 members, advise physicians who object to abortion on religious grounds to notify patients beforehand and to refer them to abortion providers.

“You need to give your patients all the options so they can make their own choice,” Julie Kwatra, legislative chair of the Arizona chapter of ACOG, told Rewire in a phone interview. “Not telling a patient information is in opposition to every rule of medicine.”

In 2012, Arizona’s right-leaning legislature instituted a religious privilege law that shields health-care professionals who hold religious beliefs from losing licensure.

These protections, critics argue, further stigmatize a legal medical procedure that’s already under attack in GOP-held legislatures nationwide.

MomDoc’s website and advertisements make no mention of its faith-based opposition to abortion rights, pro-choice advocates note.

“Drive down the freeway and every other billboard will be a MomDoc billboard on how they provide midwife care and how they really care about the family,” Kat Sabine, executive director of NARAL Arizona, said in a phone interview with Rewire. “To me it’s almost like locking down and cordoning off abortion care even more than it is in the community.”

By asking its employees to refrain from discussing abortion care, MomDoc runs counter to prevailing professional health-care norms to inform and refer patients, explained Lori Freedman, author of Willing and Unable, a book about doctors’ constraints on abortion.

“I think there’s an ethical problem there—this is information patients would want,” Freedman said a phone interview with Rewire.

It’s impossible to know how many religiously run practices across the country try to silence employees when it comes to abortion care. The executive director of the American Association of Pro-Life Obstetricians and Gynecologists said the group has not polled its 2,500 members on whether they refer patients to abortion providers, but said the organization’s overall position is “abortion hurts women.”

A recent attempt to muzzle a Washington, D.C., OB-GYN grabbed national headlines after her employer told her not to “put a Kmart blue-light special on the fact that we provide abortions.” Although the facility where the provider works doesn’t restrict access to abortion care, the case and MomDoc’s policy are both rooted in a federal measure called the Church Amendment.

Adopted in 1973 shortly after the landmark Supreme Court ruling Roe v. Wade, the Church Amendment offers protections for health-care workers at federally funded institutions who object to participating in abortions for moral or religious reasons. Attorneys for a Washington OB-GYN are arguing in a complaint filed with the Office for Civil Rights that those protections also extend to doctors who wish to speak up in favor of abortion.

MomDoc’s abortion taboo pervades its hiring and employment practices, former employees told Rewire. They asked Rewire not to reveal their names, fearing employment reprisals. Local OB-GYNs familiar with MomDoc, or whose colleagues had interviewed with the practice or work there, helped to corroborate these accounts.

“They brought it up at the [job] interview,” said an OB-GYN who worked for nearly five years in MomDoc clinics in the Arizona towns of Gilbert and Queen Creek. “They said they don’t do abortions, don’t talk about it, don’t refer [patients].”

The OB-GYN and others felt the prohibition was a condition of employment, saying that those who opposed MomDoc’s staunch anti-choice stance “got screened out.”

Once hired, the former OB-GYN said of abortion, “I talked about it, I know other doctors talked about it.”

Indeed, the former MomDoc OB-GYN said of discussing abortion care with patients: “I would always start off telling the patient, ‘I’m not supposed to talk about this, but I will.’” 

The former OB-GYN told Rewire that she’d caution patients to stay mum, and not tell her employer.

“Kind of saying, if you tell them I did [discuss abortion], I’m going to deny it,” the former OB-GYN explained, adding that discussing abortion wasn’t something she felt would lead to her termination.

The day-to-day reality of MomDoc’s abortion taboo seemed to depend on the employee’s position. Support staff described to Rewire how supervisors and team leads imposed an ongoing gag order on abortion.

“I was told in my training that abortion was not something we did, it was not something we promoted, it was not something we referred [patients to],” said an employee who worked in surgery and referrals from 2011 to 2012.

“They told us every conversation was recorded,” said a 72-year-old former appointment setter who worked for six years in MomDoc’s corporate office in Chandler, where she was told not to provide abortion information to callers. She said she’d occasionally “sneak in” a referral to an abortion provider.

“I worked in the medical field for 35 years, and I have never been told I can’t discuss a procedure,” the former scheduler said.

Asked how the policy was enforced, a former OB-GYN said, “I don’t remember anything being in my contract about abortions; it was more of a verbal thing.”

At times, the application of the anti-choice policy seemed uneven. A former nurse practitioner, who worked in Goodman & Partridge and MomDoc facilities from 2013 to 2014, said she was warned in a job interview not to talk about Plan B, emergency contraception that helps prevent pregnancy, rather than abortion.

“I was never told that directly that I couldn’t refer patients to abortion providers,” she recalled in a phone interview. “I had patients that did choose abortion, and I referred them.”

In the end, what the former employees described perhaps exposes the practical limits of imposing a religious gag order on a legal health-care procedure on staff who may not share their employer’s beliefs. Those in a position to do so may merely pay lip service to the prohibition.

“Obviously, when you have a crying teenager in front of you,” a former MomDoc OB-GYN said, “you’re going to help them, you’re going to refer them.”

News Abortion

Study: Utah’s Forced 72-Hour Waiting Period Dissuades Few, Raises Abortion Care Costs

Nicole Knight Shine

One survey respondent was pushed beyond the abortion care facility’s gestational limit because of the GOP-backed 72-hour waiting period.

New research shows that Utah’s 72-hour forced waiting period doesn’t dissuade the vast majority of those seeking abortion care, it just makes the procedure more difficult and expensive to obtain.

The March study, published in Perspectives on Sexual and Reproductive Health, reports that 86 percent of the pregnant people surveyed ended their pregnancies, with most reporting average waits of eight days between the initial visit and the procedure. Making two visits increased the cost of abortion care by about 10 percent.

Utah requires an in-person counseling visit at least 72 hours before abortion services, necessitating two separate visits. The state was the nation’s first to enact a 72-hour waiting period in 2012. GOP-majority legislatures in South Dakota, Missouri, Oklahoma, and North Carolina have also mandated 72-hour delays. Holidays and weekends don’t count in South Dakota’s 72-hour waiting period.

In 2013 and 2014, members of the research group Advancing New Standards in Reproductive Health at the University of California, San Francisco, surveyed 500 pregnant people who were seeking abortion care at four Utah abortion providers.

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Eight percent of the 309 respondents who completed follow-up surveys reported they were no longer seeking abortion care, but most “had been conflicted at the information visit.” Three percent had miscarried or found out that they weren’t pregnant, and two percent said they were still seeking abortion care. One respondent, a 26-year-old who had given birth once before, was pushed beyond the facility’s gestational limit because of the GOP-backed 72-hour waiting period.

Those surveyed spoke frankly about the emotional toll of the state-mandated 72-hour delay, expressing “frustration at being powerless to implement their decision.” Researchers noted that few of those surveyed seemed conflicted about having an abortion, suggesting the “72-hour waiting requirement seems to have been unnecessary.”

A 22-year-old told researchers, “I had to wait like a week and a half. That was killing me. I’m a person that wants to get everything over and done with once I’ve made a decision, so that was hard. I wanted it over and done with to move on with my life.”

An 18-year-old expressed similar frustration: “Knowing that I had to wait after deciding what I wanted to do and not having control over my own life and my body made me mad.”

Karrie Galloway, CEO and president of Planned Parenthood Association of Utah, told Rewire that the health-care provider has tried to soften the impact of the forced delay on pregnant people by offering so-called informed consent sessions at eight facilities around the state, “so a woman doesn’t have to drive all the way to Salt Lake City from St. George, which is a five-to-six hour drive away in southern Utah.”

Denise Danley, a call center lead with Planned Parenthood Association of Utah, told Rewire that the researchers’ findings mirror what she hears from callers seeking abortion care.

“They have typically already done significant research about the abortion process and have carefully considered their decision,” Danley said in an email. “Making arrangements such as needing to schedule time off at work, finding transportation, and potentially needing to schedule childcare for multiple appointments is quite stressful for women as it adds to the total cost of the abortion.”

Researchers found that those who had an abortion spent a mean of $44 on costs related to the consultation visit, $103 on costs related to the abortion care appointment, and paid a mean of $387 for the abortion procedure. The mean household income of respondents was $22,000.

Danley said she often hears from callers who didn’t realize they were pregnant right away because they were taking birth control to prevent an unintended pregnancy.

“There is not much ambiguity with these women, they were responsibly taking active steps to prevent pregnancy and birth control failure, and a waiting period does not change their mind about their readiness to parent,” Danley said.

Utah had a 24-hour waiting period prior to 2012. But lawmakers in the state’s Republican-held legislature argued that a longer delay was needed to allow a “woman who’s facing that decision to fully weigh her options and the implications of that decision,” as a spokeswoman for Gov. Gary Herbert told Reuters.

“When a woman decides to end a pregnancy, she has made a carefully considered decision—a decision in which politicians have no business to interfere,” Cecile Richards, president of Planned Parenthood Federation of America, noted in a statement following the study’s release. “This study found that too often a woman in need of an abortion in Utah must scramble to find more money for the procedure, make additional travel and childcare arrangements, and then wait for days—in most cases, more than a week—to end a pregnancy. This is unacceptable, and why we fight bills like these whenever they are introduced.”