News Abortion

Tale of Two States: Louisiana Banning ‘Telemed’ Abortions, While California Expands Abortion Access

Robin Marty

One state is trying to curb safe abortion access, while the other seeks to expand it.

In an example of how much abortion access differs by state, Louisiana and California are taking very different paths when it comes to abortion policy. In Louisiana, lawmakers are trying to make it illegal to offer “telemed” abortions, while the California assembly is moving forward with legislation that would loosen abortion restrictions and add to the state’s pool of providers.

Louisiana’s SB 90 would require any medication abortion to be initiated in the physical presence of a “physician licensed to practice medicine in the state of Louisiana and [who has] completed a residency in obstetrics and gynecology.” This in a state where only three cities have abortion clinics. The state senate approved the bill Thursday, with a 36-2 vote, according to the Associated Press. It now heads to the desk of Republican Gov. Bobby Jindal, where it is likely to be signed into law.

The bill was sponsored by state Sen. Fred Mills (R-Breaux Bridge), a pharmacist, who told the Times Picayune that “his reasoning for pushing the legislation centers on his concern for a woman’s health as she terminates her pregnancy,” and that the process of a medication abortion can be “emotionally upsetting,” because of the process of first “starving” then “expelling” the pregnancy. Mills did not address how being in the physical presence of a doctor when ingesting medication would address that, as the actual “expelling” of the embryo or fetus would still happen when the patient was out of the presence of the physician.

The bill did receive a few amendments. One was to change the requirement that the pills be provided by a board-certified OB-GYN to a slightly less restrictive rule that physicians must have completed an obstetrics and gynecology residency.

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By contrast, California lawmakers have continued the push to allow more medical professionals to perform early abortions, as previously reported by Rewire. AB 154 would allow board-certified midwives and nurse midwives to perform vacuum aspirations if they receive proper training and certification. Allowing additional trained professionals to provide this early abortion technique is expected to greatly expand access in the 52 percent of counties in the state that do not have an abortion provider. The bill is still awaiting a full vote in the assembly.

“Women need quality healthcare in their own communities and without excessive wait times,” Assembly person Toni Atkins (D-San Diego), the bill’s sponsor, said in a statement. “This is particularly true with abortion services, which are cheaper and less complicated earlier in a pregnancy.”

Analysis Law and Policy

After ‘Whole Woman’s Health’ Decision, Advocates Should Fight Ultrasound Laws With Science

Imani Gandy

A return to data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous "informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

Whole Woman’s Health v. Hellerstedt, the landmark U.S. Supreme Court ruling striking down two provisions of Texas’ omnibus anti-abortion law, has changed the reproductive rights landscape in ways that will reverberate in courts around the country for years to come. It is no longer acceptable—at least in theory—for a state to announce that a particular restriction advances an interest in women’s health and to expect courts and the public to take them at their word.

In an opinion driven by science and data, Justice Stephen Breyer, writing for the majority in Whole Woman’s Health, weighed the costs and benefits of the two provisions of HB 2 at issue—the admitting privileges and ambulatory surgical center (ASC) requirements—and found them wanting. Texas had breezed through the Fifth Circuit without facing any real pushback on its manufactured claims that the two provisions advanced women’s health. Finally, Justice Breyer whipped out his figurative calculator and determined that those claims didn’t add up. For starters, Texas admitted that it didn’t know of a single instance where the admitting privileges requirement would have helped a woman get better treatment. And as for Texas’ claim that abortion should be performed in an ASC, Breyer pointed out that the state did not require the same of its midwifery clinics, and that childbirth is 14 times more likely to result in death.

So now, as Justice Ruth Bader Ginsburg pointed out in the case’s concurring opinion, laws that “‘do little or nothing for health, but rather strew impediments to abortion’ cannot survive judicial inspection.” In other words, if a state says a restriction promotes women’s health and safety, that state will now have to prove it to the courts.

With this success under our belts, a similar return to science and data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous “informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

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In Planned Parenthood v. Casey, the U.S. Supreme Court upheld parts of Pennsylvania’s “informed consent” law requiring abortion patients to receive a pamphlet developed by the state department of health, finding that it did not constitute an “undue burden” on the constitutional right to abortion. The basis? Protecting women’s mental health: “[I]n an attempt to ensure that a woman apprehends the full consequences of her decision, the State furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

Texas took up Casey’s informed consent mantle and ran with it. In 2011, the legislature passed a law that forces patients to undergo a medical exam, whether or not their doctor thinks they need it, and that forces them to listen to information that the state wants them to hear, whether or not their doctor thinks that they need to hear it. The purpose of this law—at least in theory—is, again, to protect patients’ “mental health” by dissuading those who may be unsure about procedure.

The ultra-conservative Fifth Circuit Court of Appeals upheld the law in 2012, in Texas Medical Providers v. Lakey.

And make no mistake: The exam the law requires is invasive, and in some cases, cruelly so. As Beverly McPhail pointed out in the Houston Chronicle in 2011, transvaginal probes will often be necessary to comply with the law up to 10 to 12 weeks of pregnancy—which is when, according to the Guttmacher Institute, 91 percent of abortions take place. “Because the fetus is so small at this stage, traditional ultrasounds performed through the abdominal wall, ‘jelly on the belly,’ often cannot produce a clear image,” McPhail noted.

Instead, a “probe is inserted into the vagina, sending sound waves to reflect off body structures to produce an image of the fetus. Under this new law, a woman’s vagina will be penetrated without an opportunity for her to refuse due to coercion from the so-called ‘public servants’ who passed and signed this bill into law,” McPhail concluded.

There’s a reason why abortion advocates began decrying these laws as “rape by the state.”

If Texas legislators are concerned about the mental health of their citizens, particularly those who may have been the victims of sexual assault—or any woman who does not want a wand forcibly shoved into her body for no medical reason—they have a funny way of showing it.

They don’t seem terribly concerned about the well-being of the woman who wants desperately to be a mother but who decides to terminate a pregnancy that doctors tell her is not viable. Certainly, forcing that woman to undergo the painful experience of having an ultrasound image described to her—which the law mandates for the vast majority of patients—could be psychologically devastating.

But maybe Texas legislators don’t care that forcing a foreign object into a person’s body is the ultimate undue burden.

After all, if foisting ultrasounds onto women who have decided to terminate a pregnancy saves even one woman from a lifetime of “devastating psychologically damaging consequences,” then it will all have been worth it, right? Liberty and bodily autonomy be damned.

But what if there’s very little risk that a woman who gets an abortion experiences those “devastating psychological consequences”?

What if the information often provided by states in connection with their “informed consent” protocol does not actually lead to consent that is more informed, either because the information offered is outdated, biased, false, or flatly unnecessary given a particular pregnant person’s circumstance? Texas’ latest edition of its “Woman’s Right to Know” pamphlet, for example, contains even more false information than prior versions, including the medically disproven claim that fetuses can feel pain at 20 weeks gestation.

What if studies show—as they have since the American Psychological Association first conducted one to that effect in 1989—that abortion doesn’t increase the risk of mental health issues?

If the purpose of informed consent laws is to weed out women who have been coerced or who haven’t thought it through, then that purpose collapses if women who get abortions are, by and large, perfectly happy with their decision.

And that’s exactly what research has shown.

Scientific studies indicate that the vast majority of women don’t regret their abortions, and therefore are not devastated psychologically. They don’t fall into drug and alcohol addiction or attempt to kill themselves. But that hasn’t kept anti-choice activists from claiming otherwise.

It’s simply not true that abortion sends mentally healthy patients over the edge. In a study report released in 2008, the APA found that the strongest predictor of post-abortion mental health was prior mental health. In other words, if you’re already suffering from mental health issues before getting an abortion, you’re likely to suffer mental health issues afterward. But the studies most frequently cited in courts around the country prove, at best, an association between mental illness and abortion. When the studies controlled for “prior mental health and violence experience,” “no significant relation was found between abortion history and anxiety disorders.”

But what about forced ultrasound laws, specifically?

Science has its part to play in dismantling those, too.

If Whole Woman’s Health requires the weighing of costs and benefits to ensure that there’s a connection between the claimed purpose of an abortion restriction and the law’s effect, then laws that require a woman to get an ultrasound and to hear a description of it certainly fail that cost-benefit analysis. Science tells us forcing patients to view ultrasound images (as opposed to simply offering the opportunity for a woman to view ultrasound images) in order to give them “information” doesn’t dissuade them from having abortions.

Dr. Jen Gunter made this point in a blog post years ago: One 2009 study found that when given the option to view an ultrasound, nearly 73 percent of women chose to view the ultrasound image, and of those who chose to view it, 85 percent of women felt that it was a positive experience. And here’s the kicker: Not a single woman changed her mind about having an abortion.

Again, if women who choose to see ultrasounds don’t change their minds about getting an abortion, a law mandating that ultrasound in order to dissuade at least some women is, at best, useless. At worst, it’s yet another hurdle patients must leap to get care.

And what of the mandatory waiting period? Texas law requires a 24-hour waiting period—and the Court in Casey upheld a 24-hour waiting period—but states like Louisiana and Florida are increasing the waiting period to 72 hours.

There’s no evidence that forcing women into longer waiting periods has a measurable effect on a woman’s decision to get an abortion. One study conducted in Utah found that 86 percent of women had chosen to get the abortion after the waiting period was over. Eight percent of women chose not to get the abortion, but the most common reason given was that they were already conflicted about abortion in the first place. The author of that study recommended that clinics explore options with women seeking abortion and offer additional counseling to the small percentage of women who are conflicted about it, rather than states imposing a burdensome waiting period.

The bottom line is that the majority of women who choose abortion make up their minds and go through with it, irrespective of the many roadblocks placed in their way by overzealous state governments. And we know that those who cannot overcome those roadblocks—for financial or other reasons—are the ones who experience actual negative effects. As we saw in Whole Woman’s Health, those kinds of studies, when admitted as evidence in the court record, can be critical in striking restrictions down.

Of course, the Supreme Court has not always expressed an affinity for scientific data, as Justice Anthony Kennedy demonstrated in Gonzales v. Carhart, when he announced that “some women come to regret their choice to abort the infant life they once created and sustained,” even though he admitted there was “no reliable data to measure the phenomenon.” It was under Gonzales that so many legislators felt equipped to pass laws backed up by no legitimate scientific evidence in the first place.

Whole Woman’s Health offers reproductive rights advocates an opportunity to revisit a host of anti-choice restrictions that states claim are intended to advance one interest or another—whether it’s the state’s interest in fetal life or the state’s purported interest in the psychological well-being of its citizens. But if the laws don’t have their intended effects, and if they simply throw up obstacles in front of people seeking abortion, then perhaps, Whole Woman’s Health and its focus on scientific data will be the death knell of these laws too.

Culture & Conversation Abortion

The Comic Book That Guided Women Through Abortion Months After ‘Roe’

Sam Meier

Abortion Eve used the stories of fictional girls and women to help real ones understand their options and the law. At the same time the comic explained how to access abortion, it also asserted that abortion was crucial to women's health and liberation.

“Can you picture a comic book on abortion on the stands next to Superman?”

In June 1973, Joyce Farmer and Lyn Chevli wrote to the National Organization for Women in Chicago, asking this question of their “dear sisters” and pushing them to envision a world where women’s experiences could be considered as valiant as the superhero’s adventures. They enclosed a copy of their new comic book, Abortion Eve.

Published mere months after the Supreme Court’s January 1973 Roe v. Wade ruling, Abortion Eve was intended to be a cheap, effective way to inform women about the realities of abortion. Like the few other contemporaneous comic books dealing with abortion, Abortion Eve‘s primary purpose was to educate. But for a comic dominated by technical information about surgical procedures and state laws, Abortion Eve nonetheless manages to be radical. Though abortion had so recently been illegal—and the stigma remained—the comic portrays abortion as a valid personal decision and women as moral agents fully capable of making that decision.

The comic follows five women, all named variations of “Eve,” as counselor Mary Multipary shepherds them through the process of obtaining abortions. Evelyn is an older white college professor, Eva a white dope-smoking hippie, Evie a white teenage Catholic, Eve a working Black woman, and Evita a Latina woman. Evelyn, Eve, and Evita are all married and mothers already.

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Their motivations for getting an abortion differ, too. Evita and Eve, for instance, wish to protect themselves and their loved ones by keeping their families smaller. Sixteen-year-old Evie is the poster child for sexual naiveté. Pregnant after her first time having sex, she spends most of the comic wrestling with guilt. “It’s all so ugly!” she exclaims. “I thought sex was supposed to be beautiful!”

Teenager Evie, one of the characters in the comic book Abortion Eve, breaks down as counselor Mary Multipary asks questions about her pregnancy. (Joyce Farmer)

Nonplussed, the older Eves talk her through her choices. As Eve reminds her, “Like it or not, you are a woman now, and you are going to have to decide.”

In an interview with Rewire, Farmer said that the plot of Abortion Eve was a direct outgrowth of her and Chevli’s experiences in the nascent women’s health movement. Both women had started working as birth control and “problem pregnancy” counselors at the Free Clinic in Laguna Beach, California, soon after it opened in 1970. Archival documents at Indiana University’s Kinsey Institute show that Chevli and Farmer visited Los Angeles abortion providers in December 1972, on a business trip for the Free Clinic. According to Farmer, one of the doctors they met approached the pair with the idea of doing a comic about abortion to publicize his clinic.

Earlier that year, the women had produced one of the first U.S. comic books written, drawn, and published by women, Tits & Clits alpha (the “alpha” distinguished the comic from subsequent issues). So they took the doctor’s idea and ran with it. They decided to use their newly founded comics publishing company, Nanny Goat Productions, to educate women, particularly teenagers, about abortion.

At the Free Clinic, Chevli and Farmer had seen all kinds of women in all kinds of situations, and Abortion Eve attempts to reflect this diversity. As Farmer noted in an interview, she and Chevli made sure that the Eves were all different races, ages, and socioeconomic backgrounds in order to demonstrate that all kinds of women get abortions.

Farmer had made the choice to get an abortion herself, when her IUD failed in 1970. The mother—of a 12-year-old son—who was putting herself through college at the University of California at Irvine, she decided that she couldn’t afford another child.

California had liberalized its abortion laws with the Therapeutic Abortion Act of 1967, but the law was still far from truly liberal. Before Roe, California women seeking abortions needed doctors (a gynecologist and two “specialists in the field”) to submit recommendations on their behalf to the hospital where the abortion would take place. Then, a committee of physicians approved or denied the application. Only women who could pay for therapeutic abortions—those needed for medical reasonscould get them.

For Farmer, as for so many others, the process was onerous. After an hour, the psychiatrist who had interviewed her announced that she would not be eligible, as she was mentally fit to be a mother. Stunned, Farmer told the doctor that if he denied her an abortion, she would do it herself. Taking this as a suicide threat, her doctor quickly changed his mind. She wrote later that this experience began her political radicalization: “I was astounded that I had to prove to the state that I was suicidal, when all I wanted was an abortion, clean and safe.”

Farmer and Chevli began work on Abortion Eve before Roe v. Wade, when abortion was still illegal in many states. After the Supreme Court’s decision, they added a page for “more info” on the ruling. Yet even as they celebrated Roe, the women weren’t yet sure what would come of it.

The comic reflects a general confusion regarding abortion rights post-Roe, as well as women’s righteous anger over the fight to gain those rights. On the day of her abortion, for example, Evita tells Eve that, at five months pregnant, she just “slipped in” the gestational limits during which women could have abortions.

Eve explains that women now have the right to an abortion during the first three to six months of a pregnancy, but that the matter is far from settled in the courts. After all, Roe v. Wade said that states did have some interest in regulating abortion, particularly in the third trimester.

“I get mad when they control my body by their laws!” Eve says. “Bring in a woman, an’ if the problem is below her belly button and it ain’t her appendix, man—you got judges an’ lawyers an’ priests an’ assorted greybeards sniffin’ an’ fussin’ an’ tellin’ that woman what she gonna do an’ how she gonna do it!”

Abortion Eve Dialogue

Abortion Eve confronts the reality that abortion is a necessity if women are to live full sexual lives. Writing to the underground sex magazine Screw in September 1973 to advertise the comic, Chevli noted, “Surely if [your readers] screw as much as we hope, they must have need for an occasional abortion—and our book tells all about it.”

Six months after they published the comic, in December 1973, Chevli and Farmer traveled to an Anaheim rally in support of Roe outside the American Medical Association conference. They were met by a much larger group of abortion opponents. Chevli described the scene in a letter to a friend:

300 to 8. We weren’t ready, but we were there. Bodies … acquiescing, vulnerable females, wanting to show our signs, wanting to be there, ready to learn. Oh, Christ. Did we learn. It was exhausting. It was exciting. We were enervated, draged [sic] around, brung up, made to feel like goddesses, depressed, enlightened … bunches of intangible things. I have rarely experienced HATE to such a massive extent. 

That wasn’t the last feedback that Chevli and Farmer received about their views on abortion. In fact, during the course of Nanny Goat’s publishing stint, the majority of complaints that the independent press received had to do with Abortion Eve. Several self-identified Catholics objected to the “blasphemous” back cover, which featured MAD Magazine‘s Alfred E. Neuman as a visibly pregnant Virgin Mary with the caption: “What me worry?”

As archival documents at the Kinsey Institute show, other critics castigated Chevli and Farmer for setting a bad example for young women, failing to teach them right from wrong. One woman wrote them a letter in 1978, saying “You have not only wasted your paper, time, money, but you’ve probably aided in the decision of young impressionable girls and women who went and aborted their babies.”

Farmer and Chevli responded to such charges by first thanking their critics and then explaining their reasons for creating Abortion Eve. In another response, also in the Kinsey archives, Chevli wrote, “Whether abortion is right or wrong is not our concern because we do not want to dictate moral values to others. What we do want to do is educate others to the fact that abortion is legal, safe, and presents women with a choice which they can make.”

Today, abortion opponents like Louisiana Rep. Mike Johnson (R) frame abortion as the “dismemberment” of unborn children, suggesting that women who seek abortions are, in essence, murderers. With Abortion Eve, Chevli and Farmer dared to suggest that abortion was and is an integral part of women’s social and sexual liberation. Abortion Eve is unapologetic in asserting that view. The idea that abortion could be a woman’s decision alone, made in consultation with herself, for the good of herself and of her loved ones, is as radical an idea today as it was in the 1970s.