BACKGROUND

The ability to obtain abortion care without delay is critically important to women’s reproductive health. Abortion is a safe and legal medical procedure, and it is governed by the same principles of informed consent as any other medical service.

However, many states require women to wait for some period of time—from 18 hours to three days or more—between preabortion counseling and the abortion itself. Some states require in-person counseling (rather than counseling via phone, internet or mail) before the waiting period can begin. These types of provisions mean that women must make two trips to a health care provider in order to obtain an abortion. Making two trips can pose a burden for women who need to arrange for time off from work or caretaking duties, or those who live far from abortion providers. The need to gather funds or make travel arrangements may lead women to have later, and thus riskier, abortions.

Moreover, waiting periods are medically unnecessary. They introduce an unnecessary hurdle to obtaining medical care and intrude on the patient-provider relationship—all the while failing to protect the best interests of the patient.

STATE LAWS AND POLICIES

For a chart of current laws and policies in each state related to waiting periods for abortion, see Counseling and Waiting Periods for Abortion.

For information on state laws and policies related to other sexual and reproductive health and rights issues, see State Laws and Policies, issue-by-issue fact sheets updated monthly by the Guttmacher Institute’s policy analysts to reflect the most recent legislative, administrative and judicial actions.

RELEVANT DATA AND ANALYSIS

Waiting Periods Not Based in Medicine

Waiting periods are not medically indicated or ethically mandatory as part of informed consent procedures.

  • Imposing waiting periods or requiring inaccurate or biased counseling serves no medical purpose; these hurdles are instead intended to make abortion less accessible.1,2
  • Like all health care providers, abortion providers operate under the principles of medical ethics and are required to obtain informed consent before an abortion procedure.1 Informed consent counseling should not hinder or discourage patients from making a medical decision, but rather ensure that patients have the relevant and accurate information needed to make health care decisions.
  • Waiting periods are almost never required for other medical procedures.* Those imposed on women seeking abortion are an unnecessary burden on women and single out these women as some of the only patients unable to make informed decisions without the imposition of a state-mandated waiting period.1

Women Sure About Abortion Decision

Almost all women make the decision to obtain an abortion before attempting to schedule the abortion. Waiting periods only add a delay between a woman’s decision and her procedure.

  • A nationally representative survey of abortion patients conducted in 2008 found that 92% of women reported they had made up their mind to have an abortion prior to making an appointment.3
  • Women obtaining an abortion tend to be certain of their decision. According to a study of women seeking abortion at a U.S. clinic in 2008, 99% of abortion patients reported being “sure” or “kind of sure” of their decision to have an abortion, and 98% reported that “abortion is a better choice for me at this time than having a baby.”4
  • Waiting periods can be detrimental to women’s mental health. In 2011, Texas implemented new counseling and waiting requirements that required women to make two trips to a health care provider and wait 24 hours between receiving counseling and then undergoing the abortion procedure.5 Among patients seeking abortion care after these restrictions went into place, almost one-third of those surveyed reported that the waiting period had a negative effect on their emotional well-being.

Harm in Requiring Two Trips

Some states have in-person counseling requirements, which means that a woman seeking an abortion must make two trips to her provider. Women who have to make two trips may face more complicated logistics, higher costs and delays in care.

  • Because of laws that impose an additional, medically unnecessary trip to an abortion clinic, women may encounter logistical challenges and costs related to child care, taking time off work, travel and lodging (if the clinic is not close to home).1 Such costs may act as barriers to care for low-income women, a group that experiences particularly high unintended pregnancy rates.6
  • The added complications of logistics and cost can lead to a delay in obtaining abortion care. Three in five abortion patients surveyed in 2004 who experienced a delay in obtaining an abortion reported the time it took to make arrangements and raise money contributed to the delay.7
  • A recent study of Utah’s in-person counseling law found that a 72-hour waiting period translated, on average, into eight days between counseling and procedure for those patients who obtained an abortion.8

Delays Due to Waiting Periods

Waiting periods can contribute to delays in obtaining abortion care, which is problematic because both the cost and risk of an abortion increase as the pregnancy continues​.

  • Nationwide, in 2014, abortion patients who lived in a state requiring a waiting period (with or without in-person counseling) waited 1–1.5 days longer than did patients in states with no such restrictions between making an appointment and having the procedure.9
  • Three studies conducted in Mississippi in the early 1990s found that the state’s mandatory in-person counseling and 24-hour waiting period requirement was associated with a decline in the abortion rate, a rise in abortions obtained out of state and an increase in the proportion of second-trimester abortions.1,10-12
  • Later abortion procedures are typically more costly than procedures performed at earlier gestational ages. For instance in 2011 and 2012, the median charge for a surgical abortion was $495 at 10 weeks’ gestation compared with $1,350 at 20 weeks.13
  • More than half (58%) of abortion patients in a 2008 study wished they could have gotten an abortion earlier in pregnancy.7Three in five attributed the delay in obtaining an abortion to the time it took to make arrangements and raise money.
  • The risk of complications from abortion—although exceedingly small at any point—increases with gestational age.14,15 The number of maternal deaths associated with abortion increases with the length of pregnancy, from 0.3 for every 100,000 abortions at or before eight weeks to 6.7 per 100,000 at 18 weeks or later.14 Thus, a poor woman seeking an abortion is often caught in a vicious cycle: The longer it takes for her to obtain the procedure, the harder it is for her to afford it and greater the risk to her health.16
  • Even when state laws do not ban later abortion services, many providers are not equipped or willing to provide abortions past a certain gestational age.

DATA CENTER

RECENT STATE ACTION ON THIS ISSUE

States that have addressed this issue over the past three years are listed below.

E: State enacted a relevant measure

V: State vetoed measure

A: State adopted measure in at least one chamber

States that require women to wait a specified amount of time between counseling and abortion procedure

Alabama (2014)

E

Arkansas (2015)

E

Florida (2015)

E

Kentucky (2015)

A

Louisiana (2016)

E

Missouri (2014)

E

North Carolina (2015)

E

Oklahoma (2015)

E

Tennessee (2015)

E

States that require counseling be provided in person

Florida (2015)

E

Kentucky (2016, 2015, 2014)

E

Tennessee (2015)

E

FOOTNOTES

*An exception is Medicaid-funded female contraceptive sterilization, which cannot be performed until at least 30 days after informed consent is obtained.

REFERENCES

1. Joyce TJ et al., The Impact of State Mandatory Counseling and Waiting Period Laws on Abortion: A Literature Review, New York: Guttmacher Institute, 2009, https://www.guttmacher.org/report/impact-state-mandatory-counseling-and-....

2. Boonstra HD and Nash E, A surge of state abortion restrictions puts providers—and the women they serve—in the crosshairs, Guttmacher Policy Review, 2014, 17(1):9–15, https://www.guttmacher.org/gpr/2013/03/medication-abortion-restrictions-....

3. Moore A, Frohwirth L and Blades N, What women want from abortion counseling in the United States: a qualitative study of abortion patients in 2008, Social Work in Health Care, 2011, 50(6):424–442.

4. Foster DG et al., Attitudes and decision making among women seeking abortions at one U.S. clinic, Perspectives on Sexual and Reproductive Health, 2012, 44(2):117–124.

5. Texas Policy Evaluation Project, Impact of abortion restrictions in Texas, 2013, http://www.utexas.edu/cola/txpep/_files/pdf/TxPEP-ResearchBrief-ImpactofAbortionRestrictions.pdf.

6. Guttmacher Institute, Unintended pregnancy in the United States, Fact Sheet, New York: Guttmacher Institute, 2015, http://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html.

7. Finer LB et al., Timing of steps and reasons for delays in obtaining abortions in the United States, Contraception, 2006, 74(4):334–344.

8. Roberts SC et al., Utah’s 72-hour waiting period for abortion: experiences among a clinic-based sample of women, Perspectives on Sexual and Reproductive Health, 2016, 48(4):179–187.

9. Jones RK and Jerman J, Time to Appointment and Delays in Accessing Care Among U.S. Abortion Patients, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/delays-in-accessing-care-among-us-abor....

10. Althaus FA and Henshaw SK, The effects of mandatory delay laws on abortion patients and providers, Family Planning Perspectives, 1994, 26(5):228–231 & 233.

11. Joyce T, Henshaw SK and Skatrud JD, The impact of Mississippi’s mandatory delay law on abortions and births, Journal of the American Medical Association, 1997, 278(8):653–658.

12. 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.

13. Jerman J and Jones RK, Secondary measures of access to abortion services in the United States, 2011 and 2012: gestational age limits, cost, and harassment, Women’s Health Issues, 2014, 24(4):e419–424.

14. Zane S et al., Abortion-related mortality in the United States: 1998–2010, Obstetrics & Gynecology, 2015, 126(2):258–265.

15. Upadhyay UD et al., Incidence of emergency department visits and complications after abortion, Obstetrics & Gynecology, 2015, 125(1):175–183.

16. Boonstra HD, Insurance coverage of abortion: beyond the exceptions for life endangerment, rape and incest, Guttmacher Policy Review, 2013, 16(3):2–8, https://www.guttmacher.org/gpr/2013/09/insurance-coverage-abortion-beyon....