[note on language: I use "person who is pregnant" or "patient" as gender neutral terms. While most people who are pregnant and seeking abortion care identify as women, not all of them are. While most women have a uterus and can become pregnant, not all can.]
New year, new legislatures, new anti-choice legislation. Sounds about right. Already we have new states trying out heartbeat bans, 20 week bans, mandatory non-factual counselling, TRAP laws meant to close clinics, onerous laws on administration of medical abortions, longer and longer waiting periods, and, the old favorite, mandatory ultrasounds. These laws have been making it onto the books ever since Planned Parenthood v Casey, which granted states the right to regulate abortion as long as restrictions did not create “undue burden.” (While, individually, these laws might not be huge burdens, they add up, and leave persons who are pregnant, especially persons of low-income, with abortion being legal, but out of reach).
While all of these laws are insidious and insulting, the ultrasound has become a favorite tool. The idea is that people who are pregnant (most often women) are stupid, and don’t know what pregnancy really is, and the second they see the ultrasound some sort of maternal hyperdrive will kick in and the patient will leap off the table and dash into the waiting arms of the so-called sidewalk counselors [read: harassing picketers].
The thing that is most insidious about the ultrasounds laws, currently being proposed in Arkansas, Tennessee, Kentucky, Michigan, and elsewhere, and in effect in Virginia, Texas, and others, not only that they are requiring one medical procedure, in order to allow access to another, but they couple this with requiring a person who is pregnant and seeking abortion care to see the ultrasound and hear a description of it. I know a lot of anti-choice people think that this will somehow make that person realize something or other and change their minds, but it won’t. Most people (over 60%) seeking abortion already gave birth at least once. They kinda know what pregnancy is, and what the potential end result could be, and they thought long and hard about their options before coming in.
However, a lot of the push-back against these atrocious laws is couched in saying that the state is forcing women to have an ultrasound, and often comparing it to rape. I agree that the state has no business telling doctors how to practice medicine. They aren’t doctors. They aren’t OB/GYNS.
This unfortunately has resulted in a lot of confusion on behalf of the patients I assist. They ask if there will be an ultrasound, and I tell them yes. No matter what the law says. Because they medically need an ultrasound. There are several kinds of abortions, and each procedure requires that a patient be at a certain gestation. For example, the administration of mifeprex, the patient must be under 9 or 7 weeks, depending on if you are going by the evidence based regimen, or the FDA approved regimen. If a patient comes in and says they are unsure of their last period, an ultrasound is required to determine the gestational age and see if they would be able to have a medically induced abortion.
A patient might come in and have a history of fibroids. An ultrasound must be done to determine if the doctor would be able to work around them, or if the procedure must be completed in a hospital setting.
A patient who was on depo-provera, or mirena, or seasonel, and is regularly sexually active might come in and have no clue when she got pregnant as she does not have periods. An ultrasound would have to be done to determine if the provider at the clinic would even be able to see the patient, or if they are possibly too far along for the providers skill set.
There are many reasons that ultrasounds are part of routine abortion care. The push-back pro-choice pundits are giving to the ultrasound laws, however, make it appear that ultrasounds are never done and are evil. This means patients seeking abortion care come in and are immediately defensive about needing one. This means that patients coming and medically needing an ultrasound to be done are becoming distrustful of the providers telling them that it is necessary.
What is NOT necessary is the script that accompanies the ultrasound, the waiting period after it, the description of it. The ultrasound is meant to be a diagnostic tool of the provider to determine gestational age and use that information to provide the best method of abortion care to the patient. It is not meant to be used as a means of coercing a woman out of the abortion she wants, or attempt to make a woman feel shame or guilt for an abortion she needs.
The ultrasound is being misrepresented by anti-choice politicians, it is being used as a means of controlling the thoughts of a person who is pregnant and seeking abortion care. This is wrong. But the means in which the pro-choice pundits are pushing back against the ultrasound requirements is often problematic in that it is creating confusion on whether the ultrasound is something that is needed at all. It is. The ultrasound is needed by abortion providers to ensure the best continuity of care. The push-back should be against the counseling, the description, the wait time after the ultrasound and before the procedure. Can we stop maligning the ultrasound, and instead malign the trappings being placed around it?