New abortion legislation proposed by North Carolina Republicans Tuesday not only imposes a 12-week ban, but also adds new appointment rules that doctors say will create huge barriers for abortion care at all stages of pregnancy.
For women seeking a medication abortion, the bill proposes two new requirements: one in-person appointment at least 72 hours before the patient swallows the pill, and an in-person appointment one to two weeks after.
In effect, these will require women to travel back and forth three separate times to an abortion clinic. They are already required to be in the office when they take the pill.
Doctors say the new requirements create financial and logistic barriers for women who live hours from a clinic. In North Carolina, more than half of women live in counties without an abortion clinic.
For out-of-state women traveling hundreds of miles to North Carolina for abortion care, these appointment requirements can make it nearly impossible.
“It would be untenable for out-of-state patients to get a medication abortion in North Carolina,” said Dr. Jonas Swartz, a Duke OB-GYN. “Most patients who are having abortions already have kids at home. They’re taking time off work, they’re traveling.”
In the last year, as several states began tightening abortion restrictions, North Carolina became an abortion hub for women in the South.
In the months following the fall of Roe v. Wade, the number of abortions performed in the state increased by 37%.
Now advocates and doctors worry that these additional requirements will make out-of-state abortions impractical, effectively closing off an essential access point.
“It just adds one more barrier to make it impossible,” said Dr. Beverly Gray, a Duke OB-GYN.
Fewer options, more barriers
Currently, North Carolina’s laws dictate that patients can receive state-mandated counseling in-person or by phone 72 hours before the procedure.
Swartz said the vast majority of his patients opt to hear the counseling over the phone, so they don’t have to come into the clinic multiple times. If the newly proposed abortion ban is signed into law, that option is gone.
Within North Carolina, Gray worries these new requirements will pressure more women into choosing a surgical abortion, even if that’s not necessarily what they want.
Under the proposed legislation, surgical abortions require just two in-person appointments — one 72 hours before the procedure and one the day of the procedure — potentially making it less onerous for women traveling long distances.
In North Carolina, most patients prefer taking a series of pills over undergoing a minor surgery. Nearly 60% of abortions were carried out using medications in 2020, according to data from the Department of Health and Human Services.
But with more required, in-person visits, the calculus could be different for some women.
“I think it will change how patients make decisions now that there are these additional requirements,” Gray said.
Worse, Dr. Matt Zerden fears some women will take abortions into their own hands.
Zerden, a Triangle OB-GYN, sees patients every day who have overcome tremendous barriers to show up for one in-person appointment. They’ve had to negotiate with their bosses for time off work, they’ve had to ask friends to watch their children, they’ve had to borrow cars to travel to the nearest abortion clinic.
Even a single additional appointment is sometimes too much to manage.
“If you put up all these obstacles, some will just go outside of the medical system,” Zerden said. “To mandate two extra visits for completely medically unjustified and unnecessary reasons is going to be devastating.”
Extra appointments aren’t needed, doctors say
At the press conference Tuesday night, lawmakers said the proposed changes to abortion laws were designed to “ensure the health and safety of women.”
But several doctors interviewed by the N&O said the required appointments outlined in the legislation serve no medical purpose.
They said the state-mandated “informed consent” script doctors are required to read at these appointments is not clinically useful for patients — and often confuses or upsets them instead.
State law requires doctors to tell all patients, even rape victims, that the father of the unborn baby would be required to pay child support.
They are required to offer up a state-sponsored website of resources, some of which included crisis pregnancy centers that have been known to spread misinformation about abortions.
The bill proposed Tuesday includes those same counseling requirements.
“In the time that I’ve been practicing ... the 72-hour counseling has never has added anything useful to that discussion,” Swartz said.
Furthermore, doctors say these extra appointments will create hours of unnecessary work for abortion clinics that already have months-long waiting lists.
“The health care system is already incredible strained,” Gray said. “How am I going to double the amount of appointments that have to happen?”
Teddy Rosenbluth covers science and health care for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. The N&O maintains full editorial control of the work.