Ultrasound at Center of State Abortion Wars

 
Since the 1980s, doctors have used so-called ultrasound imaging to monitor the fetus during pregnancy - checking for possible abnormalities or problems in delivery. The images - also called sonograms - have become so widespread that abortion foes say the technology has fundamentally changed the way people think about abortion.
  
This year, Oklahoma legislators handily overrode Democratic Gov. Brad Henry's veto to pass a first-in-the-nation law making the procedure mandatory at least one hour prior to all abortions. In addition, Ohio and South Dakota joined 14 other states with less stringent laws ordering doctors to give women the option of viewing an ultrasound image before they have an abortion.
  
In all, 17 states considered more than 30 ultrasound bills this year, a record level of legislative activity on any abortion issue, according to the Guttmacher Institute , an abortion-rights research group. In at least two states, Florida and Missouri, Oklahoma-style bills were defeated, and experts on both sides of the issue say they expect many more ultrasound bills next year.
 Abortion opponents argue women have a right to the most current medical information available before they decide whether to end their pregnancies. But abortion-rights activists say the laws are intrusive, arguing doctors and patients, not politicians, should decide when to use the technology.
  
Ultrasound laws are part of a larger "pro-life" movement aimed at requiring more pre-abortion counseling and longer waiting periods designed to convince women not to end their pregnancies. Twenty-eight states require doctors to provide some form of counseling about the risks of abortion and 24 require a waiting period before the procedure is performed.
In the last decade, anti-abortion politicians increasingly have shifted their emphasis from the lives of unborn babies to the physical and psychological health of women. But abortion-rights advocates say the notion that states need to help women make an informed, personal decision is demeaning and interferes with the doctor-patient relationship.
  
"Requiring doctors to perform ultrasound on all women at all stages of pregnancy is degrading and cumbersome," said Oklahoma City doctor Dana Stone. Under existing Oklahoma law, women already are informed in the mail, by phone and in person that they have a right to view an ultrasound.
  
"When they come in and find out its mandatory, they're going to be appalled and upset," Stone said. The new law takes effect Aug. 1.
  
Legal experts on both sides of the debate expect states to enact more ultrasound and other types of abortion counseling laws because of a U.S. Supreme Court decision April 18, 2007, that sided with abortion foes. In Gonzalez v. Carhart , the court upheld a federal ban on a procedure referred to by lawmakers as partial-birth abortion, and wrote in its ruling that states have a strong interest in protecting women who consider abortions.
  
So far, no ultrasound law has been challenged, but one abortion-rights organization, the Center for Reproductive Rights , is considering a suit against Oklahoma's law, according to the group's legislative counsel Celine Mizrahi.
  
Under the new statute, doctors will be required to perform the procedure on all women except in life- or health-threatening situations. In addition, they must make the image visible to the woman and discuss the condition of the fetus, including details about the arms, legs, hands, feet, facial features, beating heart and other functioning organs. No exceptions are allowed in cases of rape or incest.
  
The bill's author, Oklahoma state Sen. Todd Lamb (R), told Stateline.org the law was intended to "ensure 100 percent informed consent. We're short-changing these moms if they're not receiving an ultrasound so they can see how their child is being formed," he said.

Pro-choice advocates agree women should have access to imaging technology if they choose, but they say laws requiring the procedure are politically motivated and intended to sway women from having an abortion.

" The Oklahoma law is about political interference, not about medical information.We think a woman should be able to trust that the advice she receives from her physician reflects what her physician really believes is in her best interest, not something that her physician has been forced to say, " said Trevor Lippman of the ACLU's Reproductive Freedom Project .

Utah enacted the first ultrasound law in 1996, ordering the public health department to provide ultrasound imaging for pregnant women at no expense. That same year, South Carolina required abortion providers to perform an ultrasound when the gestational age is unknown or estimated to be more than 14 weeks.  
  
Since then, 14 more states have adopted laws giving women the option to view an ultrasound and, in some states, to listen to the heartbeat of the fetus. Several states require doctors to collect data on the number of women that choose to see an ultrasound and how it affects their decision.

While the laws aim to limit the number of abortions, doctors report that women who view ultrasound images typically do not change their minds about ending their pregnancies, according to Vicki Saporta, president of the National Abortion Federation , which represents abortion providers.
  
"Once the data is collected and analyzed, I think you'll find the laws have very little effect," Saporta said. Most abortions occur in the first trimester of pregnancy when there is very little to see in an ultrasound, she said.
  
Still, anti-abortion forces say increased use of sonograms appears to have steered many women away from ending their pregnancy. Abortion rates have fallen precipitously since 1990 and public opinion polls over the last two decades indicate a slight increase in the number of people who say they oppose abortion . Both trends may be related to a deeper understanding of what happens in an abortion, Randall K. O'Bannon, director of education for the National Right to Life Committee  told Stateline.org .
  
"Over the years, women would have an ultrasound and pass the photo around the office so everyone could see it was not just a group of cells - it was a unique special human being in there. Ultrasound eliminated the myth of a clump of cells," O'Bannon said.
  
A June 2008 poll by the Washington Post and ABC News indicates 53 percent of Americans say abortion should be legal in all or most cases, and 44 percent say it should be illegal in most or all cases.
 
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