Evidence You Can Use: Mandatory Counseling for Abortion is designed to give advocates, service providers and policymakers the data and resources they need to engage in ongoing policy discussions in their states. It includes information on state laws and policies, a synthesis of the relevant research, information on states in which the issue has been debated in the past three years and links to state-specific data. The toolkit provides an evidence base for understanding the impact of mandatory counseling on access to abortion.

BACKGROUND

Abortion is a safe and legal medical procedure that does not require expanded counseling. Abortion providers—like all medical providers—are ethically bound to provide patients with information about options, procedure details and any other information a provider deems pertinent after assessing each patient’s unique health needs and circumstances. Providers are also required to obtain informed consent, which means they must verify that patients possess the capacity to make decisions about their care, that their participation in these decisions is voluntary, and that they receive adequate and appropriate information.

However, some states have specific abortion counseling provisions, and many of these laws require providers to give inaccurate or misleading information to women seeking abortion care in order to dissuade them from obtaining an abortion. These requirements violate the principles of informed consent, intrude on the provider-patient relationship, and infringe patients’ right to receive relevant, accurate and unbiased information prior to obtaining medical care so they can make sound decisions about their treatment.

STATE LAWS AND POLICIES

For a chart of current laws and policies in each state related to mandatory counseling 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

Abortion Providers’ Adherence to Ethics for Consent

Abortion providers operate under medical principles of informed consent and are bound by the same code of medical ethics as doctors who do not perform abortions.

Women’s Certainty About Abortion

Women who obtain an abortion are sure of their decision.

Inaccurate Information on Mental Health

State-mandated counseling sometimes includes inaccurate information on the mental health consequences of having an abortion.

Inaccurate Information on Fetal Pain

Some states require abortion patients to receive inaccurate information on the ability of a fetus to feel pain at 20 weeks’ gestation.

Inaccurate Counseling on Medication Abortion Reversal

Some states require abortion counseling to include inaccurate information on the possibility of reversing a medication abortion.

Inaccurate Information on the Risks of Abortion

Some state-mandated abortion counseling includes inaccurate information linking abortion to an increased risk of breast cancer or future infertility. However, the only risk proven to be associated with abortion are the minor risks involved in the actual procedure.

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 receive counseling before having an abortion

Arizona (2015)

E

Arkansas (2015)

E

Florida (2015)

E

Kansas (2017)

E

Missouri (2017)

A

Montana (2015)

V

Oklahoma (2015, 2017)

E

Tennessee (2015)

E

Texas (2017)

A

Wisconsin (2015)

E

 

States that require counseling materials to include a statement that personhood begins at conception

Oklahoma (2015)

E

 

States that require counseling materials to include information on the ability of a fetus to feel pain

Arkansas (2015)

E

Montana (2015)

V

 

States that require counseling on the possibility of reversing a medication abortion

Arizona (2015)

E

Arkansas (2015)

E

Indiana (2017)

A

South Dakota (2016)

E

Utah (2017)

E

REFERENCES

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2. American College of Obstetricians and Gynecologists (ACOG), Informed consent, ACOG Committee Opinion No. 439, Obstetrics & Gynecology, 2009, 114(2):401–408, http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Informed-Consent.

3. National Abortion Federation, Ethical principles for abortion care, 2011, http://prochoice.org/wp-content/uploads/NAF_Ethical-_Principles.pdf.

4. Upadhyay UD et al., Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: a mixed methods study, PLoS ONE, 2017, 12(7):e0178871.

5. 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.

6. 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.

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8. American Psychological Association (APA) Task Force on Mental Health and Abortion, Report of the APA Task Force on Mental Health and Abortion, 2008, http://www.apa.org/pi/women/programs/abortion/index.aspx.

9. Brief of ACOG et al. as Amici Curiae in support of Plaintiffs-Appellants, Hope Clinic for Women v. Adams, No. 1-10-1463, Ill. App. Ct., 2011, http://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Libra....

10. National Academies of Sciences, Engineering and Medicine, The Safety and Quality of Abortion Care in the United States, Washington, DC: National Academies Press, 2018.

11. Berglas NF et al., State-mandated (mis)information and women’s endorsement of common abortion myths, Women’s Health Issues, 2017, 27(2):129–135.

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13. Foster DG et al., A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one, Psychological Medicine, 2015, 45(10):2073–2082.

14. Statement of Professor Nancy Adler, University of California at San Francisco on behalf of the APA, U.S. House Committee on Government Operations, Mar. 16, 1989.

15. Ditzhuijzen JV et al., Correlates of common mental disorders among Dutch women who have had an abortion: a longitudinal cohort study, Perspectives on Sexual and Reproductive Health, 2017, 49(2):123–131, https://www.guttmacher.org/journals/psrh/2017/05/correlates-common-mental-disorders-among-dutch-women-who-have-had-abortion.

16. Major B et al., Psychological responses of women after first-trimester abortion, Archives of General Psychiatry, 2000, 557:777–784.

17. 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, https://www.guttmacher.org/sites/default/files/pdfs/pubs/psrh/full/4223010.pdf.

18. APA, Postpartum Depression, 2007, http://www.apa.org/pi/women/resources/reports/postpartum-depression.aspx.

19. Herd P et al., The implications of unintended pregnancies for mental health in later life, American Journal of Public Health, 2016, 106(3):421–429.

20. Siu AL and U.S. Preventive Services Task Force, Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement, Journal of the American Medical Association, 2016, 315(4):380–387, http://jamanetwork.com/journals/jama/fullarticle/2484345.

21. Statement of ACOG, U.S. House Committee on the Judiciary, Pain of the Unborn hearing, Nov. 1, 2005.

22. Lee SJ et al., Fetal pain: a systematic multidisciplinary review of the evidence, Journal of the American Medical Association, 2005, 294(8):947–954.

23. Nash E et al., 2015 year-end state policy roundup, News in Context, Jan. 4, 2016, https://www.guttmacher.org/article/2016/01/2015-year-end-state-policy-roundup.

24. Delgado G and Davenport ML, Progesterone use to reverse the effects of mifepristone, Annals of Pharmacotherapy, 2012, 46(12):e36.

25. Louisiana Department of Public Health, Legislative Report on 2016 House Concurrent Resolution 87, 2017, http://www.dhh.louisiana.gov/assets/docs/LegisReports/HCR87RS20161.pdf.

26. ACOG, Facts are important: Medication abortion “reversal” is not supported by science, 2017, https://www.acog.org/-/media/Departments/Government-Relations-and-Outreach/FactsAreImportantMedicationAbortionReversal.pdf.

27. Delgado G et al., A case series detailing the successful reversal of the effects of mifepristone using progesterone, Issues in Law & Medicine, 2018, 33(1):3–14.

28. Sherman C, Medical community slams study pushing “abortion reversal” procedure, Vice News, Apr. 5, 2018, https://news.vice.com/en_us/article/a3yjd5/medical-community-slams-study-pushing-abortion-reversal-procedure.

29. Walker M, Will latest “abortion reversal” case series change practice?, MedPage Today, Apr. 4, 2018, https://www.medpagetoday.com/obgyn/pregnancy/72156.

30. National Cancer Institute, Summary report: early reproductive events and breast cancer workshop, 2003, http://www.cancer.gov/types/breast/abortion-miscarriage-risk#summary-report.

31. ACOG, Induced abortion and breast cancer risk, ACOG Committee Opinion No. 434, Obstetrics & Gynecology, 2009, 113(6):1417–1418, http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Induced-Abortion-and-Breast-Cancer-Risk.

32. Gold RB and Nash E, State abortion counseling policies and the fundamental principles of informed consent, Guttmacher Policy Review, 2007, 10(4):6–13, https://www.guttmacher.org/gpr/2007/11/state-abortion-counseling-policies-and-fundamental-principles-informed-consent.

33. ACOG, Frequently asked questions: induced abortion, 2015, http://www.acog.org/~/media/For%20Patients/faq043.pdf.

34. Zane S et al., Abortion-related mortality in the United States, 1998–2010, Obstetrics & Gynecology, 2015, 126(2):258–265, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554338/.

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

36. White K, Carroll E and Grossman D, Complications from first-trimester aspiration abortion: a systematic review of the literature, Contraception, 2015, 92(5):422–438.