Abortion

Privacy-related issues concerning abortion are complex, due in part to the amount of information about fetal development that prenatal monitoring devices make available to both patients and medical providers. Laws dictating the use of prenatal monitoring devices have led to concerns about privacy and fetal surveillance. Historically, patients, regardless of the nature of their visits to a medical provider, gained autonomy for medical decisions through informed consent laws, which give patients the right to information about the risks and benefits of medical interventions or procedures. However, in the case of abortion in the United States, such autonomy has been affected by states enacting laws restricting abortions to certain stages of pregnancy. This entry focuses on prenatal monitoring and abortion regulations, including their impact on patient autonomy and privacy.

Taking a home pregnancy test is one of the first steps many women take before having an abortion. Home pregnancy tests are available for purchase at most pharmacies and are taken in the privacy of one’s own home. The ability to detect a pregnancy early has an impact on a woman’s ability to obtain an abortion within the time frame allowed by her state, with the many of the earliest cutoffs being about 20 weeks. Home pregnancy tests work by detecting through a urine sample a hormone that is created when a fertilized egg implants in the uterus. The results become more accurate with time, with the average early detection being around 1 week after a missed period. However, because hormone levels vary from woman to woman, many home pregnancy tests instruct users to take more than one test several days apart to ensure accuracy.

Nevertheless, a woman who is pregnant may receive a negative result on a home pregnancy test. In some cases, a woman’s eggs may not implant in the uterus until as late as 1 week after a missed period; in the case of an ectopic pregnancy, the results may never appear as positive on a home pregnancy test. Thus, the recommended follow-up to a home pregnancy test is a blood test and pelvic examination performed by a medical professional. Women who have limited resources may rely on home pregnancy tests being accurate rather than spend time and money on a doctor visit. However, the longer it takes for a pregnancy to be accurately detected, the shorter the time frame the woman has to make a decision regarding parenthood.

Also under the umbrella of prenatal monitoring and abortion regulations are laws mandating that abortion providers perform an ultrasound. Many of the states that have enacted such legislation indicate that the ultrasound is required to better inform providers of fetal development and of the patient’s unique characteristics, which can affect provider’s decision making during the procedure. The data provided by the ultrasound can help providers estimate whether the fetus meets the gestational age restrictions of the states in which they are practicing. However, in some cases, this information may be used for reasons other than estimating gestational age. For example, in Florida, women seeking an abortion must consult with a doctor to determine whether the fetus is able to survive on its own; if a doctor determines that a fetus would be viable outside the woman’s body, the woman is unable to legally obtain an abortion.

Opponents of prenatal monitoring regulations argue that legislators, not medical providers, are the ones requiring ultrasounds, even though ultrasounds typically are not medically necessary for a doctor and a patient to make an informed decision about abortion, especially when the procedure is performed before 12 weeks from conception and when a fetus would not be viable outside the womb. For example, first-trimester pregnancies can be aborted through the use of a pill such as RU-486 rather than through surgery. Requiring an ultrasound, which is not medically necessary for all abortions, removes medical provider discretion when making decisions that affect the cost, discomfort, and length of procedure time for patients. Thus, opponents have argued that fetal development is monitored not with patients’ best interest or privacy in mind but with the state’s interest in determining acceptable circumstances for abortions and having citizens comply with its laws regarding abortion.

Despite these concerns, some advocates of prenatal monitoring regulations argue that mandatory ultrasounds help inform abortion seekers as well. Specifically, ultrasounds allow women to obtain an accurate estimate of the date of conception and can help inform them of the procedure likely to be the safest option based on the gestational age of the fetus. In support of informed consent laws surrounding abortion, three states mandate that the provider show and describe the ultrasound to the patient so that she can learn as much as possible about the fetus before making a final decision regarding an abortion. This ultrasound requirement is intended to allow patients to take the time to think about the procedure before determining whether they do in fact want to have an abortion. Women seeking abortions in these states are required to view these images even if they feel that ultrasound or fetal monitoring invades their privacy or that it provides more information about the developing fetus than they may wish to have (an additional 18 states require providers to permit patients to view the image on request). Opponents have argued that viewing an ultrasound is mandated surveillance of the developing fetus and potentially invades an individual’s right to privacy in two ways: (1) by requiring prenatal monitoring no matter the circumstances of the pregnancy and (2) by requiring women to view and listen to information that may not affect their decision to abort.

Knowledge of fetal characteristics is only one component of the information women may be required to view when making a decision regarding abortion. Beyond mandatory ultrasounds, state law varies in the type of information that must be presented to a woman who seeks an abortion. Seventeen states require pre-abortion counseling, with eight states requiring doctors to disclose the long-term mental health consequences of the procedure and 12 states mandating that women be informed about contested research on the possibility of a fetus to feel pain. In addition, some states require women to be informed about child support laws and government assistance available to them. Pro-choice advocates in many states argue that imposing waiting periods, viewing detailed images, listening to heartbeats, assessing fetal distress, and providing financial assistance are all attempts to present a one-sided view of the abortion issue, with no pro-choice information to counter the pro-life information required to be made available. While increased surveillance of fetal development might increase patient knowledge and promote informed consent, pro-choice advocates assert that it can present a pronatal viewpoint without addressing the challenges of parenting.

In addition to information about fetal development, prenatal monitoring technology can gather information about a woman’s lifestyle, which also raises surveillance and privacy concerns. For instance, if a woman is an illegal substance abuser, then, depending on the state in which she lives, the information collected could be used against her in criminal proceedings. Some states require a test for prenatal drug exposure if a medical provider suspects abuse, and some require medical providers to report suspected drug use. These reports can in turn be used as a basis for filing assault or child abuse charges against the woman.

Prenatal monitoring, new technology, and abortion relate to other pregnancy issues as well. Technology has improved medical providers’ ability to detect fetal developmental abnormalities, such as Down syndrome. Such knowledge about the developing fetus can also have an impact on abortion laws. For example, North Dakota has banned abortions for abnormal fetal development or genetic anomaly.

Mandatory fetal monitoring can also increase medical costs, which may affect a woman’s ability to pay for the procedure. For example, many states require a waiting period, usually 24 hours, from the time a woman seeks abortion services before the abortion can be performed. To meet this state requirement, some patients, such as those from rural areas or who live far from the clinic or hospital, might have to pay for a hotel or additional transportation. Beyond hotel and transportation costs, a mandatory ultrasound can increase the cost of the procedure. Many clinics require upfront payment of procedure costs, and many states limit public funding to only rape or incest victims. Other unanticipated costs include time off work, the length of time required for each visit (typically 4–6 hours each day), and child care for any children the woman may already have.

Some women who have had abortions as well as some providers are also using technology to educate the public on abortion experiences. For example, Emily Letts, a clinic worker, filmed her own abortion in an effort to reduce the stigma and fear surrounding the procedure. Although Letts drew criticism because a video of a woman having an abortion seems graphic and personal, her video showed only her face during a typical surgical abortion, which in early-term procedures lasts around 5 minutes. Letts’s video is not the only abortion video available online intended to educate rather than deter women from seeking an abortion, and as pro-choice advocates increase their presence online, the public can expect an increase in the number of blogs, videos, and images that aim to show a more complex picture of the feelings and mind-set surrounding abortion procedures.

Advanced medical technology will continue to change the landscape of the highly complex issue of abortion. Abortion mandates are and will continue to be complex due to the rise in information regarding fetal development made available by prenatal monitoring devices. While historically, increased usage of technology has led to greater patient autonomy, abortion regulations are playing a role in determining the balance between medical surveillance and a patient’s privacy rights and decision making.

Chastity Blankenship

See also Privacy, Medical ; WikiLeaks