Counseling and Waiting Periods for Abortion

Background

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 counseling and an abortion. In states in which counseling must be received in person (rather than via mail, fax, Internet or phone) and patients must wait a specified time period afterwards, they are effectively required to make two trips in order to obtain an abortion, a requirement that can be a hardship for some people. Moreover, several states also mandate when and how an ultrasound is performed prior to an abortion (see Requirements for Ultrasound).

Visit our state legislation tracker for policy activity on all sexual and reproductive health topics.

Highlights

  • 32 states require that patients receive counseling before an abortion is performed: 28 of these states detail the information that providers must give; 4 states have abortion-specific requirements generally following the established principles of informed consent.
    • 27 of these states also require patients to wait a specified amount of time—most often 24 hours—between the counseling and the abortion procedure.
    • 15 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.
  • 27 states direct the state health agency to develop written materials: 11 require that the materials be given to patients, 16 require that the materials be offered to them.
  • 16 states require that patients be informed that they cannot be coerced into obtaining an abortion.
  • Nearly all the states that require counseling include information about the abortion procedure and fetal development.
    • 25 states require that patients be given information about the specific procedure, while 23 require information about all common abortion procedures.
    • 30 states require that patients be told the gestational age of the fetus.
    • 26 states include information on fetal development throughout pregnancy.
  • 12 states include information on the ability of a fetus to feel pain.
  • 5 states require that patients be told that personhood begins at conception.
  • 27 states include information about the risks of abortion.
    • 8 states require medically inaccurate information that a medication abortion can be stopped after the patient takes the first dose of pills.
    • 19 states include accurate information on the potential effect of abortion on future fertility; in 3 states, the written materials inaccurately portray this risk.
    • 2 of the 7 states that include information on breast cancer inaccurately assert a link between abortion and an increased risk of breast cancer.
    • 8 of the 21 states that include information on possible psychological responses to abortion stress negative emotional responses.
  • 27 states include information on the health risks of continuing a pregnancy.

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Abortion Counseling & Waiting Periods

STATE

Length of Waiting Period

(in hours)

In-Person Counseling Necessitates Two Trips to Clinic

Written Materials Given or Offered

Patient Informed that Abortion  Cannot Be Coerced

Description of

Procedure

Fetal Development

Ability of   a Fetus to Feel Pain

Personhood Begins at Conception

Specific

All Common

Gestational Age of Fetus

Throughout Pregnancy

States with Detailed Abortion-Specific

Informed Consent Requirements (29 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

72

X

Offered

V,W

V

W

V

W

V†​,W

 

Florida

24

X

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

24

X

Offered

 

 V

V,W 

 

 

 

 

Kansas

24

 

Given

W

V

W

V

W

W

W

KentuckyЭ

24

X

Offered

 

V

 

V

W

 

 

Louisiana

24s

X

Given

W

V

W

V

W

V,W

 

Massachusetts

 

 

 

 

 

 

 

 

 

Michigan

24

 

Given

V,W 

V,W

 

V,W

W

 

 

Mississippi

24

X

Offered

 

V

 W*

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

72Ω​

X

Given

V

 

W

V

W

    W*

 

TennesseeΨ​

48▼

X▼

 

 

 

 

V

 

 

 

Texas

24

 Xξ​​

Offered

W*

 

    W*

V

W

    W*

 

UtahЭ

72

  XЭ​​

Given

W

V

W

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)

California

 

 

 

 

 

 

 

 

 

 

Connecticut

 

 

 

 

V

 

V

 

 

 

Delaware

 

 

 

 

 

 

 

 

 

 

Maine

 

 

 

 

V

 

V

 

 

 

Nevada

 

 

 

 

V

 

V

 

 

 

Rhode Island

 

 

 

 

V

 

V

 

 

 

TOTAL

27

15

27

16

25

23

30

26

12

5

Notes: V=verbal counseling; W=written materials. All states waive mandatory waiting period requirements in a medical emergency or when the patient'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. In Georgia and Rhode Island, it is waived in cases of medical emergency. ▼ Permanently enjoined by court order; policy not in effect. s  Temporarily enjoined; policy not in effect. (In Louisiana, enforcement of a 72-hour waiting period is blocked; the 24-hour waiting period remains in effect.) *   Included in written counseling materials although not specifically mandated by state law. †   Information given only to patients who are at 20 weeks of pregnancy or later; in Missouri, the law applies starting at 16 weeks of pregnancy. 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 patient be told that an abortion constitutes major surgery is enjoined. ξ   In-person counseling is not required for patients who live more than 100 miles from an abortion provider. Э  In Kentucky, a patient may be able to use telemedicine for abortion counseling. In Utah, a patient may obtain abortion counseling in person at any medical office in the state.

 

 

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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 (31 states)

Alabama

 

 

 

 

 

W†​

 

W

Alaska

 

W

 

 

W†​

W

 

W

Arizona

 

 

W†​

 

 

W

 

V,W

Arkansas

X

W†​

 

 

 

W

 

V,W

Florida

 

 

 

 

 

 

 

V

Georgia

 

W†​

 

 

 

W

 

V,W

Idaho

V

 

 

 

W†​

 

V,W†​

Indiana

V, W

 

 

 

 

 

V,W

Iowa

 

W

 

 

 

 

V,W

Kansas

 

 

W†​

 

W

 

W

V,W

Kentucky

 

 

 

 

 

 

V

Louisiana

W†​

 

 

W

 

W

V,W

Massachusetts

 

 

 

 

 

 

 

 

Michigan

 

W

 

 

 

 

W

V,W

Mississippi

 

V,W

 

V

 

W

 

V,W

Missouri

 

V,W

 

 

 

V,W

 

 

Montana

 

 

 

 

 

 

 

 

Nebraska

 X

V,W†​

 

 

 

 

W

V,W

North Carolina

 

 

 

 

 

 

W

V,W

North Dakota

s

V

 

 

 

 

 

V

Ohio

 

 

 

 

 

 

 

V

Oklahoma

W†​

 

 

W†​

W

 

V,W

Pennsylvania

 

W†​

 

 

 

W

 

V,W

South Carolina

 

 

 

 

 

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

West Virginia

 X

V

 

 

 

 

W

V,W

Wisconsin

 

V,W

 

 

 

V,W

 

V,W

States with Customary Informed

Consent Provisions (2 states)

California

 

 

 

 

 

 

 

 

Connecticut

 

 

 

 

 

 

 

 

Delaware

 

 

 

 

 

 

 

 

Maine

 

 

 

 

 

 

 

V

Nevada

 

 

 

 

 

Ф

 

 

Rhode Island

 

 

 

 

 

 

 

 

TOTAL

8

19

3

2

5

13

8

27

Notes: V=verbal counseling; W=written materials. ▼  Permanently enjoined by court order; policy not in effect. s  Temporarily enjoined by court order; policy not in effect. †   Included in written counseling materials although not specified by state law. ‡    Law specifically requires a provider to provide written information to a person seeking an abortion that depression and suicidal ideation are risks of abortion. Ф   Law requires discussion of emotional impact of abortion.