Advancing Sexual and Reproductive Health and Rights

Laws Affecting Reproductive Health and Rights:
State Trends at Midyear, 2010


In the first half of the year, more than 900 measures related to reproductive health and rights were introduced in the 45 states in which the legislature met. Although legislators continue to grapple with unprecedented budget shortfalls, bills on reproductive health and rights have been the subject of widespread debate and action. Most notably, bills restricting insurance coverage of abortion, prescribing the provision of ultrasound services for women obtaining an abortion and permitting expedited partner therapy for STIs have garnered significant attention.

At midyear, a total of 49 measures on reproductive health-related issues had been enacted in 20 states; 34 of these were related to abortion (see State Legislation Enacted in 2010). As of this writing, the legislatures in eight states and the District of Columbia remain in regular session.


Insurance Coverage of Abortion

Propelled by the enactment of the federal health care reform legislation in March, interest in state-level legislation on insurance coverage of abortion intensified through the second quarter of the year. By July 1, legislators had introduced measures on the subject in 18 states, with five new laws enacted. These measures fall into three categories—coverage under all private health insurance policies written in the state, coverage specifically in policies that will be offered through the state insurance exchanges created under health care reform and coverage in policies offered to state employees. 

Over the course of the year, legislators in five states introduced measures to restrict or prohibit coverage of abortion in all private health plans. (Five states already have such laws—see Restricting Insurance Coverage of Abortion.) Legislatures in four of these states have since adjourned, but action in Michigan remains possible this year.

Meanwhile, legislators in 14 states (including states that already have laws applying to all private plans) introduced measures that would limit coverage of abortion through the insurance exchanges that will be set up under health care reform by 2014. Legislation has been enacted in four states. Arizona’s new law permits coverage only in cases of threats to the woman’s life or health, while Mississippi’s permits coverage only in cases of life endangerment, rape or incest. Laws in Louisiana and Tennessee prohibit all coverage of abortion, with no exceptions. Legislation approved by the legislature in Missouri is awaiting action by the governor, and measures in Florida and Oklahoma have been vetoed.

Measures introduced in eight states—and enacted in two—are directed at the insurance coverage provided to public employees. The new Arizona law limits coverage to cases when the woman’s life or health would be threatened; South Carolina’s new law bans coverage in all circumstances. Including these new laws, which go into effect in July, 14 states restrict abortion coverage for public employees (see Restricting Insurance Coverage of Abortion).


Ultrasound Requirements for Women Obtaining an Abortion

Over the course of 2010, legislators in 18 states introduced bills aiming to further incorporate ultrasound into abortion procedures. These measures fall into three distinct categories: those that would require abortion providers to offer a woman access to an ultrasound procedure, those that would add requirements for providers already performing an ultrasound in preparation for an abortion and those that mandate that women seeking an abortion first obtain an ultrasound.

Legislators in eight states introduced measures to require that ultrasound services be offered to a woman seeking an abortion. Missouri was the only state in which a measure was approved, and the governor is widely expected to allow it to go into effect without his signature. Three other states currently require providers to offer ultrasound services to women (see Requirements for Ultrasound).

Measures enacted this year in Utah and West Virginia place requirements on a provider who is performing an ultrasound in preparation for an abortion. The Utah law requires the provider to offer to show and describe the image to the woman. The new law in West Virginia is similar but explicitly allows the woman to choose whether or not to view the image. These two new laws bring to 10 the number of states with such provisions. 

Finally, legislatures in three states—Oklahoma, Florida and Louisiana—moved to enact or strengthen requirements mandating that women seeking an abortion first obtain an ultrasound. Oklahoma adopted the most stringent measure. It would require abortion providers to perform an ultrasound on every woman obtaining an abortion, display the image to her and provide a verbal description; the woman would be entitled to “avert her eyes” if she did not want to view the screen. The measure is identical to one passed in 2008 that was overturned by a state court on procedural grounds. The new law, written to avoid the procedural issues, was nonetheless challenged immediately upon enactment, and enforcement is currently blocked pending the outcome of the litigation.

Two other states that have existing mandates sought to expand them, one successfully and one not. In Louisiana, a new law was enacted requiring providers to offer a woman both a picture and a verbal description of the image. (State law already required that a provider perform an ultrasound on each woman seeking an abortion and offer her the option to view the image.) A Florida measure was vetoed, however. It would have mandated an ultrasound for every woman seeking an abortion, regardless of gestation; current law requires an ultrasound only when an abortion is performed after the first trimester.


Treating Partners for STIs

Continuing a welcome trend, legislatures in several states are moving to expand access to STI testing, treatment and prevention by enacting legislation allowing health care providers to prescribe STI treatment for a patient’s partner without having examined the partner. So far this year, measures to allow expedited partner therapy have been introduced in eight states and enacted in three—Maine, Rhode Island and Wisconsin. Another measure is awaiting action by the governor in Missouri.

The new Maine law allows treatment for all STIs, while the measure enacted in Rhode Island permits treatment for chlamydia and gonorrhea; the new Wisconsin law allows treatment for chlamydia, gonorrhea and trichomoniasis. The bill awaiting gubernatorial action in Missouri would allow treatment for chlamydia and gonorrhea. The three laws enacted so far this year bring to 17 the number of states explicitly permitting expedited partner therapy (AZ, CA, IL, IA, LA, ME, MN, NV, NM, NY, ND, OR, RI, TN, UT, VT and WI).


Production of State Quarterly Trends is made possible in part by support from The John Merck Fund.