News Abortion

North Carolina Governor Opposes Appeal of Ultrasound Ruling

Emily Crockett

Gov. Pat McCrory said that "costly and drawn out litigation" would not be worth the trouble over the one provision that was struck down, which would have forced all women seeking an abortion to receive and be shown a narrated ultrasound before their procedure.

Republican North Carolina Gov. Pat McCrory said he opposes appealing a court ruling that permanently blocked a 2011 law forcing all women seeking abortions to receive and be shown a narrated ultrasound before their procedure.

McCrory said that since “the heart of the legislation remains intact,” an appeal would not be worth the state’s time and expense.

“After extensive review, I do not believe costly and drawn out litigation should be continued concerning only one provision that was not upheld by the court,” McCrory said in a statement.

The law, which was passed before McCrory took office, would have forced a provider to show a woman seeking an abortion an ultrasound four to 72 hours before the procedure, place the image in the woman’s line of sight, describe the fetus in detail, and offer the opportunity to listen to the heartbeat. The woman would be allowed to avert her eyes or try not to listen, but her objections would not stop the narration.

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The January 17 court ruling found that this amounted to state-compelled speech and a violation of doctors’ First Amendment rights.

Republican leaders of the state assembly have indicated support for an appeal, however, and Attorney General Roy Cooper will ultimately be responsible for deciding whether to appeal the ruling.

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.

News Law and Policy

Anti-Immigrant Bill Advances in North Carolina

Tina Vasquez

The bill may become law by the end of the legislative session Saturday, American Civil Liberties Union of North Carolina Acting Executive Director Sarah Preston told Rewire.

North Carolina’s HB 100, a bill that targets undocumented communities and aims to penalize cities not complying with local immigration laws, was sent to the house rules committee this week after passing the senate.

The bill could become law by the end of the legislative session Saturday, American Civil Liberties Union of North Carolina Acting Executive Director Sarah Preston told Rewire.

HB 100 expands on HB 318, the Protect North Carolina Workers Act, signed into law last year, which requires employers doing business with a “public entity” to use the federal E-Verify system to authenticate the citizenship status of job applicants, and bars government agencies and local law enforcement from verifying a person’s identity or residence using consular or embassy documents.

HB 100 will prohibit an exception in HB 318 that allows law enforcement to accept identification provided through local programs such as the FaithAction ID Initiative, which provides identification for any resident in the community “who may not have access to government issued forms of ID.”

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As ThinkProgress reported, these local ID programs were created “in partnership with law enforcement officials precisely because police wanted to make cities safer … FaithAction International House realized that undocumented immigrants were afraid to call the police when crimes occurred, fearing officers would arrest them instead because they lacked identification.”

Another bill introduced in May, SB 868, aims to prohibit law enforcement officials from being able to accept these IDs and under HB 100, these programs, popular in larger cities like Greensboro, would be illegal.

“Removing the ability to use these community IDs makes undocumented immigrants more likely to be targets of crime, because it makes them fearful to come forward and interact with law enforcement,” said Preston. “People who want to take advantage of the community know this community has very little recourse.”

What’s “incredibly troubling,” Preston said, is the reporting piece of the bill. The law allows anonymous tipsters to call the attorney general’s office and make complaints against their city, town, or local law enforcement alleging it is not following local immigration laws. As CityLab reported, a second reporting measure allows any person to “file a lawsuit asking a court to decide whether a city or county is non-compliant with state law.”

If the attorney general confirms a report that a city is not complying with the state’s anti-immigrant policies, whether these violations are intentional or inadvertent, the city’s transportation and education funding will be withdrawn for the year.

“These complaints would be anonymous and confidential and could take shape in many different ways, like someone at the county clerk’s office helping an undocumented person access records or seeing an undocumented person in court that a North Carolina resident doesn’t think is being treated as badly as they should be,” Preston said.

The attorney general would investigate “no matter how frivolous or incomplete it may be,” Preston told Rewire.

HB 100 comes on the heels of the Supreme Court’s split ruling on Deferred Action for Parents of Americans (DAPA), which would have provided an estimated 3.6 million undocumented parents of U.S. citizen or legal permanent resident children with a renewable work permit and exemption from deportation for two years. At a time when advocates are calling on cities to provide more local protections for undocumented immigrants in light of the ruling, Preston said this measure represents the “unnecessary targeting” of a community that has already been under attackboth nationally and in North Carolina—for years.

A recent series of immigration raids hit North Carolina’s undocumented communities, which comprise 7.6 percent of the population, hard. The state doesn’t have any sanctuary cities, which are regions that do not work with U.S. Immigration and Customs Enforcement for the detainment and deportation of undocumented community members.

HB 100 would actually make sanctuary cities illegal, explained Preston. And the inability by undocumented community members to access any form of identification would erode any relationship local law enforcement has been able to build with this community.

“I can’t answer why the state is going after such a vulnerable population,” Preston said. “I think it’s wrong and misguided, but I don’t have an answer. I wish I knew.”