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“There are many scenarios where patients need care after 12 weeks. Some of them receive devastating news of a birth defect. Or, at that point in pregnancy sometimes patients have medical complications. Being pregnant is very much like running a marathon. It’s hard on your body, especially if you have underlying medical conditions like high blood pressure, diabetes, heart disease, kidney disease. When you get to that point in pregnancy, some women get sick. But it’s unclear in this legislation who is sick enough for us to care for. That makes it very challenging for us to do our jobs effectively.”

ON LOGISTICAL IMPACT ON ABORTION ACCESS

Dr. Jonas Swartz, assistant professor and director of family planning in department of obstetrics and gynecology, Duke Health

“They have increased the administrative burden of providing abortion care to an almost untenable level. Currently in the state we do have a 72-hour waiting period, which is cumbersome for patients. But fortunately the initial counseling right now can take place over the phone. That’s state-mandated counseling.”

“This (new law) would require two visits with the health center for the individual. That means people would have to get childcare, take off work for an additional day for a completely unnecessary visit to get state-mandated counseling. In my time practicing in North Carolina, that state-mandated counseling we provide 72 hours prior to the abortion – we do it every time and it has been helpful zero times. We provide informed counseling and get informed consent from our patients as a component of medical care. The idea they need to have this counseling in person simply is creating administrative hurdles and making it more difficult to get abortion care.”

“Care will be limited at 12 weeks. That means there are many people who are going to be leaving the state for care. We safely provide care in outpatient settings across the state right now between 12 and 20 weeks, and this bill limits care after 12 weeks to hospitals. That provision is completely counter to any evidence on the safety and quality of abortion, which shows abortion is safe up through the second trimester in outpatient centers. So this law does not use evidence-based medicine, doesn’t allow us to practice evidence-based medicine and will restrict care to the point it will be really difficult for us to care for our patients.”

ON WHO CAN BE PUNISHED

Jolynn Dellinger, visiting lecturer, Duke Law School

“Clarity is a huge issue here, and a huge problem. It is unclear who can be prosecuted under this law. It is unclear when a physician can act in a medical emergency, it is unclear how physicians can comply with these administrative requirements.”

“It is unclear whether women can be prosecuted for self-managed abortion … can a woman be prosecuted for self-managed abortion? If the answer is no, the legislature needs to be very clear about that in this law.”

ON NEED FOR TWO-VISIT COUNSELING BEFORE ABORTION

Dr. Jonas Swartz

“What it seems to suggest is that a patient would have to come in for state-mandated counseling at least 72 hours before the abortion. There’s a lack of clarity whether the pregnant person would have to have an ultrasound at that juncture. There’s also a requirement that seems to suggest the person has to have another ultrasound – potentially a second ultrasound – four hours before the procedure. These details really matter as to how we provide care. I can’t come up with a scenario where it makes sense to provide care with all those administrative hurdles they’ve put in place … essentially it just makes people waste time.”

“When patients call our clinic, they have already thought about their decision to have an abortion for a long time, and generally they’ve come to that decision. We do, just being good doctors, review their options. Make sure it’s right for them. Make sure they’re not being coerced. But this law does nothing to help us with that process and it creates a false narrative that doctors are the ones pressuring patients into having abortion care or not offering them alternatives. That is insulting. That’s not the way we care for patients but it does create this false narrative.”

 ON ABORTIONS AFTER 12 WEEKS

Beverly Gray

“For patients who are past 12 weeks, those patients might have received a recent diagnosis of a genetic abnormality, of a birth defect on their ultrasound. Patients typically will undergo the ultrasound to review the anatomy around 18 weeks. Often people think of this of the ultrasound where you might find out the sex of the baby. For a lot of people it’s a very happy, exciting time. Other patients find out a devastating diagnosis and they need to maybe get further testing, talk to other specialists before they make a decision. It’s unclear in this bill who will be able to receive care I they receive a diagnosis of a birth defect.”

“There are many parts of our states that are maternity care deserts. They may have had to wait to get an appointment to find out how far along they are.”

ON ROLE OF LAWMAKERS

Dr. Beverly Gray

“You may have been hearing legislators saying they’ve talked to doctors about this legislation. Yes, we have tried to talk to as many legislators as will listen to us. Many of them just flat out would not talk to us about what we had to say about medicine, about evidence-based care, about the scenarios we see every single day.”

“Some of them were saying, ‘Well, I only want to talk to an OBGYN who lives in my district.’ Well, if you live in a rural district in North Carolina, it’s very likely you live in a maternity care desert, which means there might not be an OBGYN in your county who could talk to your legislator. So they closed the doors to us, to many of us.”

“The other false narrative we want to talk about is that they’re not listening to doctors that provide this care. In North Carolina there are 91 counties where there is no provider of abortion care, so patients have to travel. All of these hoops people have to jump through, to go to two or three visits to complete their care, it’s unnecessary. And for patients that live in rural North Carolina, its’ just going to be impossible.”

ON VIEWS FROM MEDICAL EXPERTS

Dr. Jonas Swartz

“Medical societies have been vocal in opposition to this bill. The North Carolina Medical Society issued a renewed reproductive health access policy which was very supportive of abortion and opposed legislative interference in the doctor/patient relationship. The North Carolina OBGYN Society supports the policy of the American College of Obstetricians and Gynecologists, in support of abortion care. The American Medical Association is supportive of abortion care; the World Health Organization is supportive of abortion care, and in the past couple days both the North Carolina Medical Society and the North Carolina OBGYN Society have issued statements specifically opposing this bill.”

“The legislators who are pushing this legislation simply are not listening to the medical community, or listening to the people their patients trust to help them make decisions and get medical care.”

ON DETERMINING CARE AFTER 12 WEEKS

Dr. Jonas Swartz

“What’s going to be the process to care for these patients with health issues between 12 and 20 weeks? The body doesn’t know you’re now 12-weeks pregnant and there’s an abortion ban so it can’t get sick anymore. No, there are progressive issues … that can get worse in pregnancy. What level of health risk do they need to rise to for us to be able to decide we can move forward with an abortion?”

“The overall effect is it’s just going to have a chilling effect on care. It’s going to make it that North Carolinians have worse healthcare, and specifically, North Carolinian women have worse healthcare.”

ON BILL RUSHED THROUGH WITHOUT PUBLIC DISCUSSION

Jolynn Dellinger

“This thing has just been whipped up behind the scenes. There have not been public hearings. There hasn’t been testimony from experts. This is an incredibly complicated topic. Moreover it’s a topic where, we’re not the first people to this party. There are 13 states that have criminalized abortion already. So we can have the model of what other states have done and how devastating the consequences have been.”

“We could have had an actual process where we had experts go in and really talk to the legislators … the failure to have any kind of expert input, the failure to have hearings, the failure to take this slow and make sure they get it right, is just another example of the erosion of the democratic process that we’re seeing all over the place.”

“The idea that this was all supposed to be returned to the people and their elected representatives, and this bandying about of the democratic process, is just strange when at every turn these individuals and groups and parties in the anti-abortion movement are undermining the democratic process.”

ON FREQUENCY OF THIRD TRIMESTER ABORTIONS

Dr. Beverly Gray

“In North Carolina they don’t happen at all. We can do some myth-busting here. Third-trimester abortions are a myth. It’s a favorite talking point of the anti-abortion coalition … but it’s not something we need to legislate against because it’s not something that happens.”

“What has happened over my time in this last decade is North Carolina has become a progressively more hostile state with respect to provision of abortion care. We have a 20-week ban. We have bans on who can provide care. We have bans on medication abortion. We have all kinds of legislation that interferes with the practice of medicine.”

ON OTHER MEDICAL PROCEDURES REQUIRING WAITING PERIODS, OTHER RESTRICTIONS

Dr. Jonas Swartz

“I cannot think of any other medical procedure that has even close to this level of regulation, and it’s ironic because abortion is one of the safest procedures we provide in medicine.”

ON MYTHS, MISCONCEPTIONS AROUND ABORTION CARE

Dr. Jonas Swartz

“Many people are just going to think they don’t have access to care. My concern is that in particular those with health conditions, that might otherwise lead them to seek abortion, might hear they can’t have abortion care after 12 weeks. We want to be able to provide compassionate care for people and look holistically and say ‘what’s the best for your health after all?’ I think this will make it more difficult for people to understand they may be able to still get access to care.”

“It’s really a misnomer that this bill does anything to protect women or to protect children. This is just an ideological bill – at least the abortion restriction components – is just an ideological bill about limiting access to something a minority group of legislators and North Carolinians disagrees with.”

ON REPRODUCTIVE HEALTH PRIVACY RISKS

Jolynn Dellinger

“These laws that interfere with when you can get care necessarily cross over into information privacy issues. If self-managed abortion is illegal, and a prosecutor chose to prosecute a person for obtaining abortion drugs, that would involve all kinds of information that individual generates in their everyday life. By using their phone, by searching the internet … by purchasing abortion medication online. All those things could be used as evidence against a person in a prosecution. Even where providers are targeted, women’s bodies and women’s information will be surveilled as part and parcel of prosecutions of physicians. And of course, providers will be surveilled.”

“This is an abortion law, and I feel that a lot of people think, ‘Oh, abortion, that’s not my issue. I don’t care one way or the other, that doesn’t affect me.’ I just want to point out any time you have a law that restricts abortion, it affects every person in the state who needs reproductive care, and anyone who cares about those individuals.”

“For pregnancy, for a healthy pregnancy, for any kind of pregnancy, for any kind of reproductive care at all. And states that restrict abortion, they have higher rates of STDs, they have higher rates of teen pregnancy, they have higher rates of maternal mortality, and all of those things will affect us all as a state. This will disincentivize people from moving here, it will disincentivize people from coming here to train, to become doctors. We have world class health care and medical facilities here. We want them to stay that way. We want to incentivize people to come to our state – businesses and families. It’s an abortion law, but it has such far-reaching consequences for everyone in our state.”

Briefing Participants

Jolynn Dellinger

 is a visiting lecturer at Duke Law School and a senior fellow at the Kenan Institute for Ethics at Duke, where she teaches ethics, privacy law and policy and works in the area of ethical tech.

Beverly Gray, M.D.

 is division chief of women’s community and population health and an associate professor in the Department of Obstetrics and Gynecology. Gray is also founder of the Duke Reproductive Health Equity and Advocacy Mobilization team. 

Jonas Swartz, M.D.

 is an obstetrician and gynecologist, an assistant professor and director of family planning in the Department of Obstetrics and Gynecology, and a researcher in reproductive health equity issues.