In the more than four decades since the U.S. Supreme Court recognized a woman’s constitutional right to end a pregnancy, states have enacted well over 1,000 abortion restrictions. Anti-choice forces are gaining ground: More than one-fourth of those restrictions were passed in the last five years. Last year alone, 17 states enacted 57 new laws limiting reproductive choice.
Many of these policies flout established medical standards, disrupt a woman’s ability to seek and act on counsel from her trusted health-care provider, and make accessing abortion care more expensive. But one bill recently signed into law in Utah, SB 234, managed to encapsulate a number of troubling harms. SB 234 requires women, with only very narrow exceptions, to undergo anesthesia if they choose abortion care after the approximate midway point of pregnancy. While only a small number of patients seek such care, at least one physician has noted that the law could also apply to women seeking to induce labor—an undoubtedly unintended consequence. And the women themselves may have to pay out-of-pocket for the anesthesia, which could cost them thousands of dollars.
To be clear, anesthesia is already sometimes used during abortion care for a variety of reasons, individual to the patient. But the type of anesthesia used is often local or regional, meaning the patient remains alert because only a portion of her body is affected. However, because of how the Utah law is written, physicians will likely be required to administer general anesthesia: the type that affects both a patient’s brain and total body, rendering the woman unconscious.
General anesthesia, while generally safe for much of the population, does not come without risk of complications, including stroke, heart attack, and even death. Previously, Utah required providers to tell a woman she had the option to undergo anesthesia when ending a pregnancy. Some women may very well choose anesthesia for their own reasons. But Utah’s new mandate forces women to put their health, and even lives, in harm’s way for no stated medical benefit to them.
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Notably, the text of SB 234 also struck a requirement that a woman’s doctor inform her of these risks as she decides whether to use anesthesia. There is a perverse logic in eliminating this requirement—the patient can no longer decide if those risks would keep her from undergoing anesthesia—but it highlights how the state has placed itself between patient and provider. No longer can a woman have a meaningful, open dialogue with a provider she trusts on the pros and cons of a medical procedure; the decision has been made for both doctor and patient by the state.
Further, abortion care, for which Utah prohibits almost all private and public insurance coverage, can be difficult for many to afford. Requiring general anesthesia, which can cost hundreds to thousands of dollars when not covered by insurance, makes the door to access safe abortion care even more difficult to open, if not entirely impossible. The bill provides no guidance on how the cost of the mandated anesthesia will be covered. This new restriction, like so many others, falls hardest on low-income women and families.
To add further insult to injury, the author of SB 234 is trained as an accountant. He admitted during debate over the bill that he didn’t know what drugs, exactly, his legislation would require doctors to force on women if they choose abortion care. Instead, he said his concern was over the idea that a fetus may be able to feel pain at this point in a pregnancy—something no reputable medical organization has found to be the case.
Anti-choice politicians and advocates have a long history of political interference when it comes to a woman’s own health care decisions. For years, states like Ohio prohibited providers from following the most up-to-date, evidence-based standards for medication abortion. And despite a recent FDA opinion clarifying these best practices, some states are still pushing the outdated requirements. Other states, such as Wisconsin, force providers to show and describe a medically unnecessary ultrasound image to most women before abortion care, even over her objection. In more than a dozen states, women are forced to undergo “counseling” that necessitates two trips to a clinic in order to end a pregnancy—not only driving up the cost of care, but also insinuating that women aren’t capable of making an informed decision without the government’s interference.
Utah’s new law, however, may be the first time a state renders a doctor’s advice moot while also forcing a woman to pay significantly for something that increases risks to her health.