Counseling and Waiting Periods for Abortion

Background

Every state requires that a patient consent before undergoing medical treatment and that the consent be “informed.” Three interrelated elements underlie the long-standing tradition of informed consent: Patients must possess the capacity to make decisions about their care; their participation in these decisions must be voluntary; and they must be provided adequate and appropriate information. However, abortion counseling requirements sometimes run afoul of these principles by requiring information that is irrelevant or misleading.

In addition to abortion counseling requirements, many states require that at least 24 hours elapse between the counseling and the abortion. In states in which the counseling must be obtained in person (rather than via mail, fax, Internet or phone) and the woman must then wait a specified time period, most often 24 hours, between the counseling and the procedure, the woman is effectively required to make two trips to the health care provider in order to obtain an abortion, a requirement that could constitute a hardship for some women. Moreover, several states also mandate when and how an ultrasound is performed prior to an abortion (see Requirements for Ultrasound).

Highlights

34 states require that women receive counseling before an abortion is performed: 29 of these states detail the information a woman must be given; 4 states have abortion-specific requirements generally following the established principles of informed consent.
- 27 of these states also require women to wait a specified amount of time—most often 24 hours—between the counseling and the abortion procedure.
- 14 states require that counseling be provided in person and that the counseling take place before the waiting period begins, thereby necessitating two separate trips to the facility.
30 states direct the state health agency to develop written materials: 11 require that the materials be given to a woman seeking an abortion, 19 require that the materials be offered to her.
15 states require that the woman be informed that she cannot be coerced into obtaining an abortion.
Nearly all the states that require counseling require information about the abortion procedure and fetal development.
- 26 states require that the woman be given information about the specific procedure, while 24 require information about all common abortion procedures.
- 32 states require that the woman be told the gestational age of the fetus.
- 28 states include information on fetal development throughout pregnancy.
13 states include information on the ability of a fetus to feel pain.
6 states require that the woman be told that personhood begins at conception.
26 states include information about the risks of abortion.
- 4 states require medically inaccurate information that a medication abortion can be stopped after the woman takes the first dose of pills.
- 22 states include accurate information on the potential effect of abortion on future fertility; in 4 states, the written materials inaccurately portray this risk.
- 5 of the 6 states that include information on breast cancer inaccurately assert a link between abortion and an increased risk of breast cancer.
- 8 of the 23 states that include information on possible psychological responses to abortion stress negative emotional responses.
30 states include information on the health risks of continuing pregnancy.

Abortion Counseling & Waiting Periods
STATE	Length of Waiting Period (in hours)	In-Person Counseling Necessitates Two Trips to Clinic	Written Materials Given or Offered	Woman Informed that Abortion Cannot Be Coerced	Description of Procedure		Fetal Development		Ability of a Fetus to Feel Pain	Personhood Begins at Conception
STATE	Length of Waiting Period (in hours)	In-Person Counseling Necessitates Two Trips to Clinic	Written Materials Given or Offered	Woman Informed that Abortion Cannot Be Coerced	Specific	All Common	Gestational Age of Fetus	Throughout Pregnancy	Ability of a Fetus to Feel Pain	Personhood Begins at Conception
States with Detailed Abortion-Specific Informed Consent Requirements (30 states)
Alabama	48		Given	V,W	V	W	V	W
Alaska			Offered		V	W	V	W	W^*
Arizona	24	X	Offered	V,W	V	W	V	W
Arkansas	48	X	Offered	V,W	V	W	V	W	V^†,W
Florida	▼	▼	Offered		V		V	W
Georgia	24		Offered			W	V	W	W
Idaho	24		Given	W	V	W		W
Indiana	18	X	Given		V	W	V	W	V^‡	V
Iowa	§	§	Offered		V	V,W
Kansas	24		Given	W	V	W	V	W	W	W
Kentucky^Э	24	X	Offered		V		V	W
Louisiana	24^§	X	Given	W	V	W	V	W	V,W
Massachusetts	▼
Michigan	24		Given		V,W		V,W	W
Minnesota	24		Offered			W	V	W	V^†,W
Mississippi	24	X	Offered		V		V	W
Missouri	72	X	Given	W	V,W	W	V,W	W	W^†	W
Montana	▼
Nebraska	24		Offered			W	V	W
North Carolina	72		Offered	V	V	W	V	W
North Dakota	24		Offered	W		W	V	W		V
Ohio	24	X	Given		V		V	W
Oklahoma	72		Offered		V	W	V	W	V^†,W	W
Pennsylvania	24		Offered	W	V	W	V	W
South Carolina	24		Offered		V	W	V	W
South Dakota	72^Ω	X	Given	V		W	V	W	W^*	W
Tennessee^Ψ	48	X					V
Texas	24	X^ξ	Offered	W*		W^*	V	W	W^*
Utah^Э	72	X^Э	Given	W	V	W	V	W	V^†,W
Virginia	24	X^ξ	Offered		V	W	V	W
West Virginia	24		Offered	W^*		W	V	W
Wisconsin	24	X	Given	V,W	V	W	V	W	W*
States with Customary Informed Consent Provisions (4 states)
Connecticut					V		V
Maine					V		V
Nevada					V		V
Rhode Island					V		V
TOTAL	27	14	29	15	26	24	32	28	13	6
All states waive mandatory waiting period requirements in a medical emergency or when the woman's life or health is threatened. In Utah, the counseling is waived if the pregnancy is the result of rape or incest or the patient is younger than 15. In Alabama, the counseling requirement is waived in cases of ectopic pregnancy or severe fetal impairment and in Georgia and Rhode Island it is waived in cases of medical emergency. ▼ Enforcement permanently enjoined by court order; policy not in effect. § Law is temporarily enjoined, policy is not in effect. (In Louisiana, enforcement of the 72-hour waiting period is blocked, the 24-hour waiting period remains in effect.) V= verbal counseling; W= written materials * Included in written counseling materials although not specifically mandated by state law. † Information given only to women who are at 20 weeks of pregnancy or more; in Missouri the law applies at 22 weeks of pregnancy and in Utah a physician may waive the requirement if the abortion is because of rape, incest, life endangerment, a severe health problem or if the fetus has a lethal condition. ‡ In Indiana, the provision is not enforced against Planned Parenthood of Indiana due to a court case. Ω The law prohibits the inclusion of weekends and annual state holidays as part of the waiting period. Ψ Enforcement of a provision of the Tennessee law requiring that a woman be told that an abortion constitutes major surgery is enjoined. ξ In person counseling is not required for women who live more than 100 miles from an abortion provider. Э In Kentucky, a woman may be able to use telemedicine for abortion counseling. In Utah, a woman may obtain abortion counseling in person at any medical office in the state.

Abortion Counseling & Waiting Periods
STATE	INACCURATE INFORMATION ON REVERSING MEDICATION ABORTION	COUNSELING ON HEALTH RISKS OF ABORTION						COUNSELING ON HEALTH RISKS OF PREGNANCY
		Future Fertility		Breast Cancer		Mental Health
		Accurately Portrays Risk	Inaccurately Portrays Risk	Correctly Reports No Link	Inaccurately Asserts Possible Link	Correctly Reports Range of Emotional Responses	Describes Negative Emotional Responses
States with Detailed Abortion-Specific Informed Consent Requirements (30 states)
Alabama						W^†		W
Alaska		W^†			W^†	W		W
Arizona			W^†			W		V
Arkansas	X	W^†				W		V,W
Florida								V
Georgia		W^†				W		V,W
Idaho	X	V				W^†		V,W^†
Indiana		V, W						V,W
Iowa		W				W		V,W
Kansas			W^†		W		W	V,W
Kentucky								V
Louisiana		W^†					W	V,W
Michigan		W					W	V,W
Minnesota		V,W^†		V,W^†		W		V,W
Mississippi		V,W		V	W^†			V,W
Missouri		V				V,W
Nebraska		V,W^†					W	V,W
North Carolina							W	V
North Dakota		V						V
Ohio								V
Oklahoma		W^†			W^†	W		V,W
Pennsylvania		W^†				W		V,W
South Carolina		W^†				W		W
South Dakota	X	V	W^†				W	V,W^†
Tennessee								V
Texas		V	W	V	W		W^†	V,W
Utah	X	W				W		V,W
Virginia		W				W		W
West Virginia		V					W	V,W
Wisconsin		V,W				V,W		V,W
States with Customary Informed Consent Provisions (2 states)
Maine								V
Nevada						Ф
TOTAL	4	22	4	3	5	15	8	30
V= verbal counseling; W= written materials ▼ Enforcement permanently enjoined by court order; policy not in effect. † Included in written counseling materials although not specified by state law. ‡ Law specifically requires the provider to inform in writing a woman seeking an abortion that depression and suicide ideation are risks of the abortion. Ф Law requires discussion of emotional impact of abortion.

Source URL: https://www.guttmacher.org/state-policy/explore/counseling-and-waiting-periods-abortion