Over the last several months, there have been a number of mischaracterizations in the media regarding a new law that will bring common-sense health and safety standards to clinics which provide abortions in the state of North Carolina. Contrary to what many activists have said, the legislation does nothing to change federal law or limit woman’s right to choose.
What are the health and safety provisions in the new law?
There are two. The first will allow the Department of Health and Human Services (DHHS) to apply the same safety and hygiene standards to abortion clinics that now cover outpatient surgery centers. These commonly-accepted health standards were put in place to safeguard patients seeking personal medical care at outpatient (or “ambulatory”) surgery care facilities. Any type of surgery carries with it the inherent risk of medical complications, and abortion-related complications can include infection, excessive bleeding, and uterine perforation. While uncommon, these complications can sometimes be significant enough to require hospitalization or further surgery.
Fortunately for everyone, the risks involved to the mother’s life during a surgical abortion are extremely low. And while statistics vary, according to the Guttmacher Institute, the chances of death associated with abortion in the United States is just one out of every 29,000 women (at 16-20 weeks pregnant) and just one out of every 11,000 women (at 21 or more weeks).
But by expanding existing safety and hygiene standards to cover all facilities that provide outpatient surgical abortions, all North Carolina’s women, rich and poor alike, can finally access sanitary facilities and share in better quality medical care.
But aren’t North Carolina’s clinics safe and clean now?
Everyone wants them to be; health risks to women only increase in those facilities which fall short of maintaining basic standards of safety and hygiene. In the last decade, under already existing regulations, over 200 citations have been issued against clinics — and more recent violations of these long-established regulations are troubling indications that future improvements need to be made.
In May, a clinic in Charlotte with past violations was temporarily shut down because it posed “an imminent threat to the health and safety of patients.” The clinic was found to be improperly administering chemical abortions and improperly examining post-abortive women before they were being discharged from surgery. Women were being told to drink a chemical used to induce abortion, when it was supposed to be administered only by injection.1 A clinic in Durham was temporarily shut down in June because its lack of quality-control procedures in blood banking procedures that also posed an imminent threat to patients. And most recently, a clinic in Asheville had its license temporarily suspended for violating 23 separate rules involving basic health, safety, and hygiene. The same clinic in downtown Asheville had its license suspended for similar violations seven years ago, the last time it had been inspected.
How often are abortion clinics typically inspected?
According to the Department of Health and Human Services, the state is only able to inspect abortion clinics every 3-5 years. Currently, there are only 10 full-time staff DHHS staff members to monitor the safe operation of 16 clinics and nearly 300 hundred other facilities that provide these procedures across the state.
What is the other health and safety provision?
The second provision deals specifically with physician standards. The new law requires that a licensed doctor be physically present during the entire surgical procedure, something that’s not currently the case. In many busy clinics, doctors can leave women and girls unattended; sometimes these doctors don’t follow-up with their patients after the procedure has been completed. The law also directs that when a drug is used to induce an abortion (rather than surgery) the physician must be physically present at least when the first dose of medicine is administered.
But don’t these provisions restrict access?
The law specifically prohibits restrictions to patient access. From Section 4(c): “The rules shall ensure that standards for clinics certified by the Department address the on-site recovery phase of patient care at the clinic, protect patient privacy, provide quality assurance, and ensure that patients with complications receive the necessary medical attention, while not unduly restricting access.”
What about the other restrictions in the law?
Reasonable people can disagree, but the law really only contains three restrictions: the first prohibits taxpayer funds from being used to pay for abortions in the new healthcare exchanges established under the Affordable Care Act (except where the pregnancy is the result of rape, incest, or when the life of the mother is at risk); the second restriction prohibits city and county governments from using taxpayer dollars to pay for insurance plans that offer abortion coverage (except where the pregnancy is the result of rape, incest, or when the life of the mother is at risk); and the third restriction prohibits a doctor from knowingly performing an abortion when the purpose is to select the child’s gender.
But I heard that this law rolls back the point at which a woman may legally get an abortion.
No. Nothing in the new law changes existing state laws regarding the point at which a woman may obtain an abortion. Women are able to legally obtain an abortion in North Carolina anytime during the first five months of pregnancy when the procedure is performed by a licensed physician in a certified hospital or clinic. After that time, an abortion is lawful if continuing the pregnancy threatens the life of the woman or would gravely impair her health. Existing law also says that the parent of a minor wanting an abortion must get her parent’s consent for it.
What else does the law do?
A few things. The new law expands the so-called “conscience provisions” to include additional kinds of healthcare workers (besides just doctors and nurses, as is the case under current law) to opt-out of participating in an abortion procedure if they have any moral, ethical, or religious objections. It also shields these healthcare workers from liability for damages and from any disciplinary actions as a consequence of opting-out.
The law also protects the privacy of women should they be involved in any related court proceedings, and it directs DHHS to make resources available on its website to women who, in the process of having an ultrasound, learn that their unborn child might have a disability or other serious abnormality.
1. Susan B. Anthony List: “Kermit Gosnell is Not an Outlier”