Analysis eyes abortion counseling requirements
Results from a new Guttmacher Institute analysis indicate that current state-mandated abortion counseling requirements often violate core principles of informed consent.1 In 23 states where providers are required to give information in verbal or written form, such information often falls short of fundamental ethical principles due to inaccuracies or irrelevancy, the analysis reveals.
In the review, analysts found that written materials in 18 states include descriptions of abortion procedures performed after the first trimester of pregnancy, even though this information is irrelevant to the nine in 10 women who have an abortion during the first 12 weeks of pregnancy. In addition, four states (Idaho, Oklahoma, South Dakota, and Texas) use graphic descriptions of late-term procedures that attempt to steer women away from having an abortion, the analysis notes.1
Written counseling materials in six states (Alaska, Kansas, Mississippi, Oklahoma, Texas, and West Virginia) inaccurately assert that a link may exist between abortion and breast cancer, a claim that has been rejected by the National Cancer Institute (NCI) and thoroughly studied2,3
In addition, when analysts looked at materials from South Dakota, Texas, Utah, and West Virginia, they found statements that assert that a woman undergoing an abortion may experience suicidal thoughts or suffer from "post-abortion traumatic stress syndrome," a disorder that is not recognized by major mental health organizations. "If you're going to mandate materials, and your point is that you want women to have true, informed consent, then this material needs to be accurate," says Vicki Saporta, president and CEO of the National Abortion Federation (NAF). "We believe that women should have access to all the accurate medical information that they need to make informed decisions about their pregnancies, and they can't do that if they are being given misleading information."
Check NAF materials
NAF's clinical policy guidelines are evidence-based and are based on known patient outcomes, says Saporta. The guidelines are reissued every year to reflect the most information, she states. (Editor's note: Review the guidelines at the organization's web site, www.prochoice.org; click on "Professional Education," "Educational Resources," and "Clinical Policy Guidelines.")
Obtaining informed consent and assessing that the decision to have an abortion is made freely by the patient are essential parts of the abortion process, explains Saporta. NAF guidelines uphold five standards:
- Accurate information must be provided regarding the risks and benefits of abortion.
- There must be documentation that the patient affirms that she understands the procedure and its alternatives, the potential risks, benefits and complications, that her decision is uncoerced, and that she is prepared to have an abortion.
- Women must undergo the abortion as expeditiously as possible in accordance with good medical practice.
- Birth control information must be available to patients at the facility.
- All reasonable precautions must be taken to ensure the patient's confidentiality.
NAF periodically reviews state mandates and regulations for accuracy when it comes to abortion policy, says Saporta. It will supply published documentation and other support material so that such mandates and regulations reflect accurate information. "Sometimes we have more success than other times in having them actually change the language of these materials so that they do in fact reflect accurate, evidence-based information," Saporta states.
Watch the language
Inaccurate or irrelevant information in state-mandated materials is problematic in light of the Supreme Court's recent decision in Gonzalez v. Carhart which gives deference to legislatures, rather than the weight of the evidence, in cases where there is medical disagreement on the potential consequences of abortion, according to the new analysis.1,4 Some state legislatures may view the ruling as a green light to add information that may run counter to the principles of informed consent.
In the Gonzales v. Carhart opinion, Justice Anthony Kennedy states in his decision that women who have abortions come to regret their choices and consequently suffer from "severe depression and loss of esteem" — even though he cites no evidence in support of this claim, and, in fact, concedes there is "no reliable data to measure the phenomenon," notes Eve Gartner, JD, senior staff attorney with the Planned Parenthood Federation of America. In sharp contrast to Justice Kennedy's stance about the emotional effects of abortion, Justice Ginsburg's dissent makes it clear that the most credible medical and scientific evidence demonstrates that abortion does not cause mental health problems, notes Gartner.
While nothing in Justice Kennedy's opinion alters the standard set out in the Supreme Court's 1992 Planned Parenthood of Southeastern Pennsylvania v. Casey decision that information required to be given to a woman seeking abortion is 'truthful and not misleading,' we fully anticipate that legislatures, relying on Justice Kennedy's words, will nonetheless push the envelope by attempting to pass laws requiring that women seeking abortion be given unnecessary, ideologically motivated, and in some cases, inaccurate and deceptive information — all under the pretext of ensuring that women are informed about their decision," states Gartner. "Planned Parenthood Federation of America pledges to continue to fight for laws that ensure that our patients receive honest and accurate information about abortion and other reproductive health care services."
- Gold RB, Nash E. State abortion counseling policies and the fundamental principles of informed consent. Guttmacher Policy Review 2007; 10:6-13.
- National Cancer Institute. Summary Report: Early Reproductive Events and Breast Cancer Workshop. Accessed at: www.cancer.gov.
- Beral V, Bull D, Doll R, et al. Breast cancer and abortion: Collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries. Lancet 2004; 363:1,007-1,016.
- Gonzales v. Carhart, 2007 U.S. LEXIS 4338 (2007).