Evidence You Can Use: Waiting Periods 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 waiting periods on access to abortion services.

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 waiting periods are medically unnecessary. They introduce an unnecessary hurdle to obtaining medical care and intrude on the patient-provider relationship, while failing to protect the best interests of the patient. 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, and for those who live far from an abortion provider. The need to gather funds or make travel arrangements may lead women to have later abortions, which are more expensive and can pose a higher risk.

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

Lack of Medical Need for Waiting Periods

Waiting periods are not medically necessary and conflict with the principles of medical ethics.

Women Sure About Abortion Decision

Women are confident in their decision to have an abortion. Mandated waiting periods only add a delay between a woman’s decision and her procedure.

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. 

Unnecessary Clinic Trips

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

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

Iowa (2017)

E

Wyoming (2019)

A

 

States that require counseling to be provided in person

Pennsylvania (2017)

A

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-waiting-period-laws-abortion-literature-review.

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/2014/03/surge-state-abortion-restrictions-puts-providers-and-women-they-serve-crosshairs.

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

4. 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.

5. 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.

6. 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.

7. 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.

8. Jerman J et al., Barriers to abortion care and their consequences for patients traveling for services: qualitative findings from two states, Perspectives on Sexual and Reproductive Health, 2017, 49(2):95–102, https://www.guttmacher.org/journals/psrh/2017/04/barriers-abortion-care-and-their-consequences-patients-traveling-services.

9. Roberts SCM et al., Do 72-hour waiting periods and two-visit requirements for abortion affect women’s certainty? A prospective cohort study, Women’s Health Issues, 2017, 27(4):400–406.

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

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

12. 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-abortion-patients.

13. 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.

14. 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.

15. 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.

16. 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, https://www.guttmacher.org/sites/default/files/pdfs/pubs/journals/j.whi.2014.05.002.pdf.

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

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

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

20. Boonstra HD, Abortion in the lives of women struggling financially: why insurance coverage matters, Guttmacher Policy Review, 2016, 19:46–52, https://www.guttmacher.org/gpr/2016/07/abortion-lives-women-struggling-financially-why-insurance-coverage-matters.

21. Guttmacher Institute, Unintended pregnancy in the United States, Fact Sheet, 2016, http://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html.

22. Roberts SCM 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.