New abortion legislation is sweeping the country, with states introducing ever-more polarizing bills to constrict and expand access. With Justice Brett Kavanaugh on the bench, legislatures in states like Georgia, Alabama and Mississippi are pushing the envelope as they presume the Supreme Court may be receptive to rolling back or overturning the landmark Roe v. Wade decision that legalized the procedure. North Carolina has been issuing legislation aimed at restricting abortion providers, patients and employers since 2011. Recent legislation that outlawed abortions past 20 weeks was overturned as unconstitutional, but lawmakers in this state continue to introduce bills to place further restrictions on abortion provision. Current proposed legislation includes House Bill 28, which would ban abortions after 13 weeks and House Bill 22, which would require doctors to tell women that some medical abortions can be reversed halfway through.
Host Frank Stasio talks with freelance journalist and editor Jo Yurcaba about the situation for patients and providers in North Carolina. He also talks with Elizabeth Nash about the national currents that seem to be sweeping toward the 2020 elections. Nash is the senior state issues manager at the Guttmacher Institute, a research and policy organization committed to advancing sexual and reproductive health and rights globally. And he speaks with Mara Buchbinder, associate professor of social medicine at the University of North Carolina at Chapel Hill, about the way abortion providers respond when restrictive abortion legislation is passed.
Jo Yurcaba on previous abortion legislation in NC:
In 2011, the General Assembly passed a law that requires a pregnant person to undergo counseling and an ultrasound before an abortion. And it also requires a physician to describe the image that they see on an ultrasound despite the fact that that's medically unnecessary. And then, in 2015, they passed another law that requires state-directed counseling that's designed to discourage people from having an abortion. And then they also passed a law that requires that someone waits 72 hours before seeing a physician and between when the procedure is provided. And that's meant to dissuade people from getting abortions. And it's built on this idea that they're going to change their mind, even though we have little evidence that that ever happens.
Jo Yurcaba on a proposed bill that would further limit abortions:
The law was that you cannot have an abortion after 20 weeks. And as you mentioned, a federal judge recently struck that down. And he specifically cited Roe v. Wade, where the Supreme Court said that viability should be determined on a case-by-case basis by a physician and there really is no determined week period when viability occurs … House Bill 28 would ban abortions after 13 weeks. And that is incredibly early in a pregnancy. The majority of abortions take place usually between nine and 13 weeks, but 10 percent do take place later than that. And so that would really seek to ban a good portion of abortions even though there's no reason for us to believe that 13 weeks is a cut-off point for viability.
Mara Buchbinder on TRAP laws and their effect:
My colleagues and I did some research looking at the impact of a 2011 law that, among other things, mandated that abortion providers offer counseling with certain content dictated by the state … What's different about these laws is that they often require non-medical content. And so, for example, in North Carolina providers are required to say that the father of the pregnancy would be required to pay child support if the pregnancy were carried to term, and that women would have access to assistance from the state if their pregnancy were carried to term … It was really difficult for them, in some cases, to offer this counseling that they viewed as harmful to certain patients. And so they develop strategies to distance themselves from the the content of what they're about to say by saying something like: I'm required by state law to give you this information, but I just want you to know that I don't necessarily agree with what I'm going to tell you.
Mara Buchbinder on the “conscience rule:”
The purpose of that rule was to protect the rights of physicians and other healthcare workers and healthcare entities that might want to refuse to offer certain health care services for moral or religious reasons. So this is interesting to me, in part, because when we hear about conscience in the news, it often focuses on the ethics of refusal. So, under what circumstances can providers refuse to participate in various health care — often having to do with reproductive services, but end of life services as well. And then also the question of, if they do refuse, are they obligated to refer patients to other providers who can provide that service? One of the things that has really come out of a lot of the work that I've done is that conscience can also be a positive force in medicine, and it can really compel providers to offer certain kinds of health care as well. And I think that that's sort of another side of the conscience debate that we're not hearing enough about.
Elizabeth Nash on why restricting access to abortions affects some groups more than others:
If you're thinking about the fact that a typical abortion costs $500, most people are paying out of pocket. If you have to travel — as the way Jo is describing from the center of North Carolina — you have a 72-hour waiting period. You're talking about travel arrangements. You're talking about finding a car, perhaps. You're talking about taking time off of work that probably isn't paid. And you're talking about arranging for childcare, because you know 60 percent of people who are seeking an abortion already have a child. So you're talking about layering on a very large, heavy financial burden that really a lot of people — maybe not quite half of people — say that if they were had a burden of $400 or $500 placed on them, they wouldn't be able to come up with that money … It would hit those with low incomes, people of color and young people hardest.