Illustration by Eleanor Doughty
Louisiana is poised to become the fifth state that requires women to wait 72 hours before getting an abortion. But women say this doesn't stop them from getting the procedure—it just denies them control over their bodies and creates an unnecessary financial burden.
On most Tuesdays, the waiting room at Women's Health Care Clinic in New Orleans is full of patients arriving for day one of the abortion process. They watch an informational video about the procedure, ask the doctor questions, and flip through brochures created by the state of Louisiana titled "A Woman's Right to Know."
Then, one by one, each women is called into an exam room to receive an ultrasound—where the technician is required by law to ask if she wants to listen to the fetal heartbeat, hear a description of the size and shape of the fetus, and keep a printed photograph of her uterus. Hours later, all of these women are sent home, still pregnant. They will have to return the next day to have their abortions.
Mandatory waiting periods are currently active in 28 states across the country; over half require in-person counseling first, meaning that women must make two back-to-back trips to get the procedure. That travel time often leads to increased expenses associated with transportation costs, childcare, and sometimes even an overnight stay.
"It's just drags it out," said one patient who asked to be kept anonymous. She was in the New Orleans clinic for her second visit. "I'm not gonna change my mind. It seems like it's something that all could have been done in one day: one appointment, one day. And it would have saved me a lot of money."
Abortion procedures can be done in one day, and they have been for decades. But since the Supreme Court upheld a mandatory 24-hour waiting period for Pennsylvania women in 1992, the scales have tipped. About 59 percent of women in the US currently live in a state with a required waiting period. And now, they're getting longer. In 2012, Utah set the precedent for bumping that wait time up from 24 hours to three days. Three other states—Missouri, North Carolina, and South Dakota—followed suit. And now Louisiana is poised to become the fifth.
Representative Frank Hoffman is the author of the sinister-sounding "Women's Enhanced Reflection Act," which mandates that women "reflect" for 72 hours before they can return to the clinic for their procedure. It was approved by the Louisiana House in a landslide bipartisan vote on April 6 and is currently snaking its way through the state legislature. Democratic Governor John Bel Edwards has already voiced his support for the proposed law, so the likelihood of its passage is high.
The Right to Know pamphlet is required to be in the waiting rooms at all Louisiana clinics. It is authored by the State Department of Health and Hospitals. All photos by Gina Pollack.
"The bill empowers women considering abortion with additional reflection time," said Deanna Wallace, the Legislative Director of Louisiana Right to Life, "so women can consider their options more effectively." Wallace advised Hoffmann directly throughout the legislative process. Her job, like that of her counterparts in other states, is to coordinate testimonies and provide research and support for pro-life bills.
The main argument in favor of mandatory waiting periods is that women need more time to consider their options. The amount of time that women take to make a decision to end a pregnancy, of course, varies from person to person. But for Wallace, what matters is the time women have to think after the mandatory counseling that they receive on their first visit.
However, the information provided in that mandatory counseling is highly selective. The brochures lying around in the Louisiana waiting rooms draw connections between breast cancer and abortion, a correlation long deemed misleading by medical journals. Each fetal illustration in the booklet is referred to as "your baby's body." A pink highlighted box next to a drawing of a full term baby, points out the "Risk of Death," noting that six women died in 2007 from abortion complications. The box doesn't mention that the rate for any complications at all from abortion, including fatality, is less than one percent. Another highlighted box kindly reminds readers that by 20 weeks, the fetus can "experience pain," but the brain structure that supports consciousness begins to take shape between 24 and 28 weeks. While intentionally subtle, when read in full, it becomes clear that the brochure is biased, with language that is both confusing and negative.
Pro-choice advocates argue that like the mandatory counseling, the waiting period requirement is just another restriction designed to deter women from having the procedure.
"If a patient says they need more time, we're happy to give them time," said Dr. Bhavik Kumar, a physician at Whole Women's Health in Texas, which has a mandatory 24-hour waiting period. "But a state mandating that everyone who comes in needs more time is insulting to women, it's demeaning, it makes the process a lot more complex, and it's medically unnecessary."
That's essentially what University of California researchers found when they conducted a study with patients who waited 72 hours in Utah. Because of appointment availability and the logistical challenges inherent in going to a clinic and returning exactly three days later, the waiting period caused an average of eight days of waiting; this led to increased anxiety for patients, who were then pushed further into their pregnancies. And because the price of an abortion increases weekly, waiting that extra time pushed the costs for the procedure 10 percent higher than they would have been had patients been able to access the service sooner. According to the study, "the four most common reasons for waiting more than 72 hours were appointment availability (48 percent), the woman's own logistics (19 percent), the need to make financial arrangements (9 percent) and the need for more time to think (6 percent)."
One 22-year study respondent said that the process was difficult, "just being ready to do it and still having the baby grow while you're trying to wait."
"I knew the longer it took, the more money it would cost," said another respondent who already had one child. "We are living paycheck to paycheck as it is, and if I [had] gone one week sooner, it would have been $100 less."
Knowing that I had to wait after deciding what I wanted to do and not having control over my own life and my body made me mad.
And the real kicker is that, despite all that, the mandatory wait did not cause the women to change their minds. Only 8 percent of the women surveyed decided not to go through with the procedure—but most of them were still in the process of deciding when they arrived for the first counseling visit. The number of patients who actually changed their minds is closer to two percent.
"Our main finding is that the vast majority of women had made their decision by the time they arrived at the clinic," said Sarah Roberts, who authored the study. "The mandatory wait just created more hardships for them."
The most common difficulty women reported during the wait was just wanting the whole process to be done. One 22-year-old in the Utah study said that the wait was frustrating because she wanted to get it over with and move on with her life. Another patient wrote, "Knowing that I had to wait after deciding what I wanted to do and not having control over my own life and my body made me mad."
But for Wallace and her team at Louisiana Right to Life, the required wait before getting an abortion is "just like a lot of other important decisions that require people to wait three days." Her examples include waiting to get married after receiving a marriage license and waiting the required three days between closing a mortgage and receiving an offer. "I think it makes perfect sense to extend that to a decision that's not only life-changing, but one that's life-ending, like abortion," she said.
Marriage and mortgages are serious decisions. But waiting period requirements don't apply to every other choice—like buying a gun, for example. What's more life-ending than that? I asked Wallace if Louisiana has a waiting period for purchasing a firearm. She wasn't sure.
"I do know that when I got my pistol, I didn't have to wait," she said. Currently, only 10 states have mandatory waiting periods for purchasing firearms, including handguns and assault weapons. Louisiana is not one of them.
A nauseous patient waits to be called in for the procedure at Women's Health Care Center, New Orleans.
But the implications of requiring waiting for a decision that only effects women's bodies is inherently fraught in a way that waiting for mortgages is not. "It's riddled with misogyny," said Dr. Kumar. "It's male lawmakers saying that when women come in for an abortion, we have to tell them something and then from that, they need time to think about it, because they can't think on their own."
Wallace and Louisiana Right to Life say that the waiting period is also designed to protect victims of coercion and violence. "The 72 hours will give them enough time to seek help," she says.
But coercion laws for abortion are already in place, and clinic administrators are aware of the signs. "In no way do we pressure them into it," said Sylvia Cochran, the head administrator of the clinic in New Orleans. "When a patient seems emotionally distraught and unsure about their decision," she said, "the doctor will say, 'Look. You seem upset. Go home, think about it, and if you still want to do it in a week, I'm not changing the price."'
The author of the Enhanced Reflection Act, Rep. Hoffmann, did not respond to my requests for an interview, but he did give a speech at a Pro-Life Legislation Press Conference in Monroe, Louisiana, back in 2014 that makes his objective quite clear. "We've been named the top pro life state in America for the past three years, at least," he said. "And we do it through making it tough to get an abortion." Until Roe v. Wade is overturned, he explained, "we want to make it as difficult as possible."
And therein lies the real problem with trying to bring science into the equation. Wallace, for one, doesn't feel that the Utah study provides any indication about the effects of increased waiting periods. Of the 309 women surveyed, the ones that stuck out to her most were the two percent of women who did change their minds.
"If this law saves one woman from the regret of having lost her child, then I think it's something worth doing," she said, in regards to the study.
But Roberts sees a different conclusion to her findings. "It seems more appropriate to provide individual counseling instead of a blunt policy that requires everyone to wait a particular amount of time," she said. "That counseling is already in practice in most abortion facilities."
Roberts hopes that people considering similar waiting period legislation in other states will use her findings for guidance. But based on the current political climate in Louisiana, studies based in empirical evidence just won't be convincing enough.
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