GUTTMACHER INSTITUTE
STATE POLICIES IN BRIEF &*o:.2»
WH Counseling and Waiting Periods for Abortion
BACKGROUND: Every state requires that a patient consent before undergoing medical treatment and that the consent
be “informed.” Three interrelated elements underlie the long-standing tradition of informed consent: Patients must possess
the capacity to make decisions about their care; their participation in these decisions must be voluntary; and they must be
provided adequate and appropriate information. However, abortion counseling requirements sometimes run afoul of these
principles by requiring information that is irrelevant or misleading.
In addition to abortion counseling requirements, many states require that at least 24 hours elapse between the counseling
and the abortion. In states in which the counseling must be obtained in person (rather than via mail, fax, Internet or phone)
and the woman must then wait a specified time period, most often 24 hours, between the counseling and the procedure,
the woman is effectively required to make two trips to the health care provider in order to obtain an abortion, a
requirement that could constitute a hardship for some women.
HIGHLIGHTS:
= 34 states require that women receive counseling before an abortion is performed: 24 of these states detail the
information a woman must be given; 10 states have abortion-specific requirements generally following the
established principles of informed consent.
= 25 of these states also require women to wait a specified amount of time—most often 24 hours—
between the counseling and the abortion procedure.
= 7 states require that all counseling be provided in person and that the counseling take place before
the waiting period begins, thereby necessitating two separate trips to the facility.
= 24 states direct the state health agency to develop written materials: 8 require that the materials be given to a
woman seeking an abortion, 16 require that the materials be offered to her.
= 9 states require that the woman be informed that she cannot be coerced into obtaining an abortion.
= Nearly all the states that require counseling require information about the abortion procedure and fetal
development.
= 32 states require that the woman be given information about the specific procedure, while 19
require information about all common abortion procedures.
= 32 states require that the woman be told the gestational age of the fetus.
= 23 states include information on fetal development throughout pregnancy.
= 10states include information on the ability of a fetus to feel pain.
= 9 states provide information on accessing ultrasound services. (See also Requirements for Ultrasound.)
= 22 states include information about the risks of abortion.
= 18 states include accurate information on the potential effect of abortion on future fertility; in 2
states, the written materials inaccurately portray this risk.
= 5 of the 7 states that include information on breast cancer inaccurately assert a link between
abortion and an increased risk of breast cancer.
= 7 of the 20 states that include information on possible psychological responses to abortion
describe only negative emotional responses.
= 28 states include information on the health risks of continuing pregnancy.
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ABORTION COUNSELING & WAITING PERIODS
STATE Length of In-Person Written Woman Description of Fetal Development: Ability of | Accessing
Waiting Counseling Materials Informed Procedure: a Fetus to| Ultrasound
Period Necessitates | Givenor {that Abortion Specific | All Gestational | Throughout | Feel Pain | Services
(in hours) | Two Trips to Offered Cannot Be Common} Age of Fetus | Pregnancy
Clinic Coerced
States with Detailed Abortion-Specific
Informed Consent Requirements (24 states)
Alabama 24 Given VW Vv Ww Vv WwW
Alaska Offered Vv Ww Vv Ww w
Arkansas Prior day Offered Vw Vv w Vv Ww v,tw
Georgia 24 Offered Vv Ww Vv WwW VW Vv
Idaho 24 Given Vv Ww WwW
Kansas 24 Given Vv Ww Vv WwW WwW
Kentucky 24 Offered Vv Vv WwW
Louisiana 24 x Given Vv Ww Vv Ww vi
Massachusetts v
Michigan 24 Given V.W V.W Ww
Minnesota 24 Offered Vv Ww Vv Ww vw
Mississippi 24 x Offered 7 Vv Ww
Missouri 24 x Given Vv Ww Vv WwW wr WwW
Montana v
Nebraska 24 Offered Vv Ww Vv WwW VW
North Dakota 24 Offered Vv Vv WwW
Ohio 24 x Given Vv Vv WwW
Oklahoma 24 Offered Vv Ww Vv WwW vw VW
Pennsylvania 24 Offered WwW Vv Ww Vv WwW
South Carolina 1 Offered Vv Ww Vv WwW
South Dakota 24 Offered Vv w Vv Ww w
Texas 24 Offered Vv w Vv w w
Utah 24 x Given Vv Ww Vv WwW v Vv
Virginia 24 Offered Vv Ww Vv WwW
West Virginia 24 Offered w v Ww Vv WwW
Wisconsin 24 x Offered W Vv Ww Vv Ww V.W
States with Customary Informed
Consent Provisions (10 states)
Arizona 24 5 V V
California Vv
Connecticut Vv Vv
Delaware v Vv Vv
Florida Vv Vv
Indiana 18 xX Vv Vv Vv
Maine Vv Vv
Nevada Vv Vv
Rhode Island Vv Vv
Tennessee” v Vv
TOTAL 25 7 24 9 32 19 32 23 10 9
All states waive mandatory waiting period requirements in a medical emergency or when the woman’s life or health is threatened. In Utah, the
waiting period requirement is waived if the pregnancy is the result of rape or incest, the fetus has grave defects or the patient is younger than 15.
The counseling requirement is waived in cases of ectopic pregnancy or severe fetal abnormality (Alabama) and in cases of a medical emergency
(Georgia and Rhode Island).
V= verbal counseling; W= written materials
V Enforcement permanently enjoined by court order; policy not in effect.
Enforcement temporarily enjoined by court order; policy is not in effect, pending the outcome of litigation.
Included in written counseling materials although not specifically mandated by state law.
Information given only to women who are at 20 weeks’ gestation or more; in Missouri the law applies at 22 weeks gestation.
The law also requires the information to be included in the written materials; however, the materials have not yet been updated.
Enforcement of a provision of the Tennessee law requiring that a woman be told that an abortion constitutes major surgery is enjoined.
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GUTTMACHER INSTITUTE OCTOBER 1, 2010
ABORTION COUNSELING & WAITING PERIODS
STATE COUNSELING ON HEALTH RISKS OF ABORTION COUNSELING
Future Fertility Breast Cancer Mental Health ON HEALTH
Accurately Inaccurately Correctly Inaccurately Correctly Reports | Describes Negative RISKS OF
Portrays Risk | Portrays Risk | Reports No Asserts Range of Emotional Emotional PREGNANCY
Link Possible Link Responses Responses
States with Detailed Abortion-Specific
Informed Consent Requirements (24 states)
Alabama w
Alaska wt wt Ww
Arkansas wi w
Georgia wt Ww
Idaho Vv wt
Kansas wt wt w
Kentucky
Louisiana wt w
Massachusetts,
Michigan Ww w
Minnesota vw v,wt Ww V.W
Mississippi v.wt Vv w v.w
Missouri Vv
Montana
Nebraska v.wt Ww VW
North Dakota Vv Vv
Ohio Vv
Oklahoma wr wr WwW VW
Pennsylvania wi Ww VW
South Carolina wt wt Ww
South Dakota Vv wt w v,wt
Texas Vv WwW Vv WwW Ww VW
Utah Ww v.w
Virginia Ww Ww
West Virginia Vv wt Ww VW
Wisconsin NAW NAW NAW
States with Customary Informed
Consent Provisions (10 states)
Arizona Vv
California
Connecticut
Delaware
Florida Vv
Indiana Vv
Maine Vv
Nevada ®
Rhode Island
Tennessee Vv
TOTAL 18 2 4 5 13 7 28
V= verbal counseling; W= written materials
+ Included in written counseling materials although not specified by state law.
® Law requires discussion of emotional impact of abortion.
CONTINUED
GUTTMACHER INSTITUTE
OCTOBER 1, 2010
FOR MORE INFORMATION:
For information on state legislative and policy activity, click on
Guttmacher’s Monthly State Update and for state level
information and data on reproductive health issues, click on
Guttmacher’s State Center. To see state specific abortion
information click on State Facts About Abortion.
Warren JT, Harvey SM and Henderson JT, Do depression
and low self-esteem follow abortion among adolescents?
evidence from a national study, Perspectives on Sexual
and Reproductive Health, 2010, 42(4):230-235.
Joyce TJ et al., The Impact of State Mandatory Counseling and
Waiting Period Laws on Abortion: A Literature Review, New
York: Guttmacher Institute, 2009.
Boonstra H, Comprehensive Medical Review Concludes
Abortion Does Not Harm Women’s Mental Health, Guttmacher
Policy Review, 2008, 11(4):20.
Gold RB and Nash E, State abortion counseling policies and the
fundamental principles of informed consent, Guttmacher Policy
Review, 2007, 10(4):6-13.
Richardson CT and Nash E, Misinformed consent: the medical
accuracy of state abortion counseling materials, Guttmacher
Policy Review, 2006, 9(4):6-11.
Boonstra H et al., Abortion in Women’s Lives, New York:
Guttmacher Institute, 2006.
Cohen SA, Abortion and mental health: myths and realities,
Guttmacher Policy Review, 2006, 9(3):8-11 & 16.
Joyce T and Kaestner R, The impact of Mississippi's mandatory
delay law on the timing of abortion, Family Planning
Perspectives, 2000, 32(1):4—13.
Henshaw SK, Factors hindering access to abortion services,
Family Planning Perspectives, 1995, 27(2):54-59 & 87.
The State Policy in Brief series is made possible in part by support from The John Merck Fund.
GUTTMACHER INSTITUTE
OCTOBER 1, 2010
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