Key Points

  • As of January 2009, 24 states require that women must receive counseling with certain state-specified information and then wait, usually for 24 hours, before an abortion can be performed.
  • A literature search identified 12 studies of the impact of mandatory counseling and waiting period laws.
  • The clearest documented impact was obtained from analyses of Mississippi’s mandatory counseling and waiting period law, which requires an additional in-person visit before the procedure. Following enforcement of the law, abortion rates fell, the number of women going out of state for an abortion rose and the proportion of second-trimester abortions increased.
  • Waiting period laws that allow mandatory counseling to be delivered over the Internet or by mail or telephone appear to impose relatively little cost on patients, and neither the waiting period requirement nor the mandatory counseling has a measurable impact on reproductive outcomes, other than to postpone the timing of some abortions.
  • Some studies found large impacts of these laws on infant and child health, as well as on suicide rates. However, these findings are implausible, given the small or undocumented increase in unintended childbearing associated with the laws and the limited data on infant and child well-being.
  • Many studies of mandatory counseling and waiting period statutes have limitations, including incomplete data and inadequate controls for factors other than the imposition of the law.
  • Future research should aim for straightforward designs. Researchers should strive for transparency by showing prelaw trends in outcomes among those who were exposed and unexposed to the laws. They also should clearly discuss expected outcomes, statistical power and the plausibility of their findings.