Duke University Researchers Suggest Chilling Effect Of Abortion Restriction In NC

Laws banning abortion have taken effect in multiple states since the U.S. Supreme Court overturned Roe v. Wade in June 2022. North Carolina forbids abortions after 20 weeks of pregnancy, and Republicans in the state legislature are debating further restrictions.

“We have moved beyond the theoretical in terms of what the harms of these laws will be,” said Dr. Jonas Swartz, one of three Duke obstetrician gynecologists who discussed the impact abortion restrictions have on reproductive health care Friday during a virtual briefing for the media.

On where abortion access stands in North Carolina in relation to neighboring states:
Dr. Beverly Gray, division chief of women’s community and population health and an associate professor in the Department of Obstetrics and Gynecology

“North Carolina is already a restricted state when it comes to access to abortion. We have one of the strictest waiting periods in the country, with a 72-hour waiting period and state-mandated counseling that we’re required to review with patients before they can see us for care. There are restrictions around administration and medication abortion, which are not evidence-based. So we’re already living under a lot of restrictions. Since the fall of Roe the 20-week ban went back into place.”

“And while abortion care in the second trimester at or around 20 weeks is very rare, these cases often represent a time when something terrible has gone wrong with the pregnancy, and patients have something going on in their life that impacts their need to see care and to see us in our clinic.”

“Most of the states surrounding North Carolina have strict bans, and while we’re still allowing care through 20 weeks, that means patients are sometimes crossing state lines to receive care after their restrictions are set in their state.”

“What we’re worried about right now is that further restrictions may impact care for the women in our state who are seeking evidence-based care. And we know the legislature is currently considering additional bans. There’s a lot of discussion around a 13-week ban, or even a six-week ban.”

Dr. Jonas Swartz, an obstetrician and gynecologist, an assistant professor and director of family planning in the Department of Obstetrics and Gynecology

“I think the first thing that we need to remember is that there’s a reason that the American Medical Association, that the American College of Obstetricians and Gynecologists, that the World Health Organization, all reinforce, all state that abortion is evidence-based health care and access to … abortion is really important to help keep our patients healthy.”

“So you know a circumstance we commonly care for is people who have gone for their anatomy ultrasound around that 18- to 20-week time period. Now people often think of that ultrasound as an exciting time when they may get to learn the sex of the baby and see on the … screen. But it’s actually a really important time where our maternal fetal medicine colleagues take a full inventory and look really carefully at the anatomy of the developing fetus, and it’s often at that time that they identify fetal anomalies or changes in the fetal anatomy that can mean that may threaten the life of the baby in the future, or may mean that that baby would face significant health consequences, maybe multiple surgeries, once it’s born.”

“… And right now, because of the 20-week ban, they are rushed in that process. We actually do the anatomy ultrasound earlier than other states that have access to abortion a few weeks later in pregnancy, precisely because we want people to have more time to make those decisions. Oftentimes people we cannot see some of the anatomic development.”

How abortion restrictions affect maternal and infant mortality:
Dr. Brenna Hughes, an obstetrician and gynecologist and an associate professor in the Department of Obstetrics and Gynecology

“Even before the Dobbs decision and the fall of Roe, there was a lot of data, unfortunately, showing that in states that have more restrictions on gestational age at abortion access or other restrictions … there is an increased risk of maternal mortality. We know that there is a maternal mortality crisis in the United States. Currently we are among the worst of developed nations for our maternal mortality rates in North Carolina.”

“There are also a good bit of data showing that there is an increased risk of infant mortality in states with more restrictions on abortion, and, in fact, the more restrictions the worse.”

Additional problems evidence shows a 13-week ban could cause:
Dr. Beverly Gray
“If we have a ban at 13 weeks or six weeks, I mean, most patients don’t know they’re pregnant at six weeks and, you know, to make a ban at that point then have a 72-hour waiting period at six weeks, that would be essentially an all-out ban. It’s very complicated to get care before that point, and then for a ban at 13 weeks, it’s an arbitrary point in the pregnancy to choose a ban at 13 weeks and I think at that stage patients are still seeking more information about their pregnancy, and you can imagine, let’s say a patient has genetic screening at the earliest point in pregnancy that they might be getting, just sort of initial counseling. They may not have a diagnostic test that tells them whether some things were wrong with their pregnancy or not. And so they’re having to rush a decision. If they want to see care in our state it’s very problematic.”

“Bans are not created based on evidence-based medicine, but the care we provide is based on evidence-based medicine and forcing patients to comply with complicated rules veiled in safety will actually make care less safe in other states with strict bands.”

“It’s impacting patients and their ability to receive evidence-based care and the reality is that bans will not just impact abortion care, but it will impact miscarriage care, early pregnancy care. It will impact care of patients who are reproductive age with other medical conditions. So things like lupus or rheumatoid arthritis, and they need medications. … Some physicians may be hesitant to give those medications. So there’s this chilling effect that happens on the care of patients, and we would see substandard care and a lot of aspects. And I think the other worry that I have is that a 13-week ban is just a stepping stone to further bans with the goal of a complete abortion ban in our state.”

Dr. Brenna Hughes
“(I)t would be near impossible to detect anomalies in a timely enough fashion, in order to provide patients with the option to pursue termination for severe anomalies. Most patients don’t know they’re pregnant by the time we’re at six weeks. Most patients are just beginning prenatal care by 12 weeks. Most have not had an ultrasound at that point, and would not have a reason necessarily to think that they would need a careful anatomic survey at that point. So, unless there was essentially a completely fatal abnormality that could be seen very early, it would mean that we would miss the vast majority, probably over 90% of anomalies.”

“If we were to start evaluating before 13 weeks and think about providing care at that time, it would make it essentially impossible.”

On the negative impacts of a patchwork of abortion laws
Dr. Jonas Swartz, who studied public understanding of abortion law

“So what we found in that study was that people were very unfamiliar with the laws on abortion in their state. And the truth is that there’s this patchwork of laws that are changing in a lot of places. It’s really tough to keep track of, of what’s going on, what the laws and regulations are in your particular state, and that may be a barrier (to seeking care). So it may mean that you think that you can get care when you, in fact, can’t, or it may mean that you think that you can’t get care when you in fact can.”

“I think it’s really important again to emphasize what Dr. Gray was saying about the chilling effect on other types of treatment that people may get both in and outside of pregnancy. We know from our colleagues and other states that now people are having more difficulty getting access to medications, that they need to treat their heart conditions to treat their lupus to maybe treat cancer, even if they’re not pregnant. And you know, those sorts of decisions need to be made by people.”

“That decision is something that needs to be made in a in a room between a person and a doctor, not impeded by this legislation. Overall, the effect is that women simply aren’t able to get the same standard of medical care as their male counterparts. That is, you know, totally unjust. It’s, I think, outside what the legislators maybe intend with this legislation, but it is a byproduct.”