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State-by-State Policies Impacting Access to Reproductive Healthcare and Abortion Services

Updated: Jun 5

By: Kalani Phillips, MPH, CPH & Nayelie Benitez Santos, MS


Background

Throughout the United States (U.S.) there are a variety of laws and regulations that either grant or prohibit access to reproductive health and abortion services for individuals. Some states have policies that require individuals seeking an abortion to have a preabortion ultrasound conducted. This requirement is not based on science and medically unnecessary for anyone in their first trimester (Requirements for Ultrasound, 2022) and creates an additional barrier for individuals seeking this service.


Access to abortion care in the U.S. is known to be restricted by various geographical, financial, and other socioeconomic and structural barriers that have intensified throughout the progression of the COVID-19 pandemic. However, telehealth has created a unique opportunity to remove these barriers and increase access to medical services, including reproductive care like abortion (Upadhyay et al., 2020).


Expanding Access through Telehealth

Research has shown that telehealth has increasingly been utilized among various abortion clinics to successfully provide medication abortion care (Upadhyay et al., 2020). Moreover, states implementing changes due to the COVID-19 pandemic also reported omitting the preabortion ultrasound requirement, allowing quick pickup of the abortion medication, and even mailing medication directly to patients after Telehealth consultations (Upadhyay et al., 2020).


Despite this, many states have yet to implement these changes (Upadhyay et al., 2020). While states have generally increased their use of telehealth among abortion clinics, most states still require preabortion ultrasounds (Upadhyay et al., 2020). As research has shown, medication abortion is medically safe regardless of a preabortion ultrasound being conducted (Requirements for Ultrasound, 2022), emphasizing a need to reduce this additional barrier to create more positive experiences and patient-centered care.


State-by-State Policies: Requiring Verbal or Written Material on Ultrasound Services

States have differing policies, laws, and requirements in place for reproductive care access. A total of 13 states require individuals seeking abortion care to receive verbal counseling or written materials on ultrasound services (Requirements for Ultrasound, 2022).

  • States requiring verbal counseling on ultrasound services

  • Georgia

  • Indiana

  • Utah

  • States requiring written materials on ultrasound services

  • Kansas

  • Michigan

  • Missouri

  • North Carolina

  • South Carolina

  • Texas

  • States requiring both verbal counseling and written materials on ultrasound services

  • Idaho

  • Montana

  • Nebraska

  • New Hampshire

  • Oklahoma

  • Wisconsin


State-by-State Policies: Requiring Ultrasounds, Displaying Ultrasound Image, and/or Describing the Ultrasound Image

While a total of 28 states regulate ultrasound services at abortion clinics, these regulations vary by state.

  • 6 states mandate abortion providers to actually perform the ultrasound in addition to showing and describing the ultrasound image to the patient

  • Arkansas

  • Kentucky

  • Louisiana

  • Tennessee

  • Texas

  • Wisconsin

  • 11 states mandate abortion providers to perform the ultrasound, in which 8 of these 11 states mandate the provider to offer the opportunity to view the sonogram image

  • States requiring only the ultrasound

  • New Hampshire

  • North Carolina

  • Oklahoma

  • States requiring both the ultrasound and the option to view the ultrasound image

  • Alabama

  • Arizona

  • Florida

  • Indiana

  • Iowa

  • Kansas

  • Mississippi

  • Ohio


Additionally, some states mandate abortion providers to give the option to view the ultrasound image, but only if the provider actually performs an ultrasound. These states include:

  • Georgia

  • Idaho

  • Michigan

  • Montana

  • Nebraska

  • New Hampshire

  • Ohio

  • South Carolina

  • Utah

  • West Virginia

Lastly, a total of 6 states mandate that patients be given the opportunity to view the ultrasound image, but they are not actually required to view it. These states include:

  • Iowa

  • Missouri

  • North Dakota

  • South Dakota

  • Utah

  • Wyoming


Nuanced State-by-State Policies

Within these states, there are more nuanced policies and requirements that affect access to reproductive care. For instance, Ohio mandates providers test for a fetal heartbeat, which requires an ultrasound be conducted if in the first trimester of pregnancy (Requirements for Ultrasound, 2022). Other states like Wisconsin, Texas, Louisiana, and Arkansas allow the patient to look away from the ultrasound image (Requirements for Ultrasound, 2022). In Louisiana, Texas, and Virginia, patients can decline listening to the provider's description of the image (Requirements for Ultrasound, 2022). Other states including Louisiana, Texas, and Arizona all require an ultrasound to take place at least 24 hours prior to the abortion (Requirements for Ultrasound, 2022), whereas other states do not have this requirement. Utah also requires that the patient be offered the option to hear a detailed description of the ultrasound image if an ultrasound is performed (Requirements for Ultrasound, 2022).


While preabortion ultrasounds are medically unnecessary for medication abortion care, some patients do request ultrasounds themselves. In these cases, Montana, Nebraska, and New Hampshire also mandate that the abortion provider display the sonogram image for the patient to view (Requirements for Ultrasound, 2022).


Conclusion

In all, reproductive care access is strongly influenced by state policies and laws that can create unnecessary barriers during a critical time in an individual's life. Studies have shown that preabortion ultrasounds are routine and not medically necessary for abortions in the first trimester of pregnancy (Requirements for Ultrasound, 2022). The inconsistencies in requirements between states highlight a need to address these public health issues and reduce barriers to care.


These additional barriers work to delay a person’s abortion care and can lead to unnecessary additional costs as ultrasounds may not be covered by insurance and can be expensive. It is therefore critical that we inform policymakers to expand reproductive care access through Telehealth and to reduce these additional requirements that hinder access. Abortion care is healthcare, so why not remove barriers and increase access to care?



Sources:

  1. Requirements for Ultrasound. (2022, April 1). [Institute]. GUTTMACHER INSTITUTE. https://www.guttmacher.org/state-policy/explore/requirements-ultrasound

  2. Upadhyay, U. D., Schroeder, R., & Roberts, S. C. M. (2020). Adoption of no-test and telehealth medication abortion care among independent abortion providers in response to COVID-19. Contraception: X, 2, 100049. https://doi.org/10.1016/j.conx.2020.100049




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