North Carolina: Reproductive Care and Abortion in the Tar Heel State

We’re headed today to the Tar Heel State —North Carolina— for our discussion of abortion care, reproductive care, and reproductive rights across the United States. As you know if you have been reading this series, abortion access and laws differ greatly across the US, especially in the aftermath of the Supreme Court of the United States (SCOTUS) decision on the Dobbs versus Jackson Womens Health Organization abortion case this past June. The Dobbs case involved Mississippi’s Gestational Age Act, which prohibits all abortions subsequent to 15 weeks gestation, with very few exceptions. In the Dobbs case, the Mississippi law was upheld by the SCOTUS 6-3. Of the six SCOTUS justices voting in favor of the Mississippi law, only one, Chief Justice Roberts, did not favor overturning the 1973 Roe v Wade decision. The other five justices that voted in favor of Mississippi’s 15 week ban, voted to overturn the entire Roe framework.

This has changed things slightly in North Carolina in that, due to North Carolina’s own laws, it puts the limit for abortions at 20 weeks and 6 days gestation, meaning a few weeks earlier than what the cutoff was prior to Dobbs. For most abortion seekers, this does not make much differences, since most abortions are performed early in pregnancy anyway, long before the 21st week. However, it could make a difference in cases of women receiving diagnosis of certain genetic conditions from samples obtained through amniocentesis close to the midpoint of pregnancy and whose decision might rest on such genetic issues. This can involve very severe chromosomal anomalies.

In our discussion, we have learned that various states, such as New York, Connecticut, Illinois, Oregon, and Washington to name a few, are so supportive of abortion rights that they are becoming destinations for abortion seekers from other US states. North Carolina current fits into this category too. Given its location in the American southeast, it’s actually somewhat of an island for abortion care. States where abortion is either restricted severely or prohibited in the after math of Roe, such as Tennessee, South Carolina, and Georgia are becoming sources of abortion seekers headed to the Tar Heel state.

In North Carolina, you can obtain a medication medication abortion (which is possible up to 77 days gestation) as well as a procedure abortion, meaning abortion requiring instruments. One such procedure is called a D&C, which stands for dilatation and curettage. Curettage is a kind of scraping of the inner lining of the uterus. Extracting a pregnancy, either viable or not, is only one of several reasons for performing a D&C. D&Cs can be performed for diagnostic reasons, such as when there’s a suspicion of abnormal cell growth in the endometrium. Therapeutic D&Cs can be performed for removing products of conception, but also for removing overgrowth of the uterine lining. D&C by itself is adequate only early in pregnancy, so after a certain point the next option is dilatation and suction. This means that, after the cervix is dilated, the doctor suctions out the products of conception. Sometimes this can be done with a syringe, but often it requires power suction. A tube called a cannula is inserted through the opened cervix. Cannulae come in a range of sizes that are chosen based on how far along the pregnancy is, or was before it became inviable. In some cases, following suction, the doctor may then perform some curettage to extract any remaining products of conception.

North Carolina’s Democrat Governor Roy Cooper and the state’s Attorney General Josh Stein both are committed to protecting reproductive care and the right to choose, but this does not mean that there are no restrictions at all for abortion seekers in the Tar Heel State. Due to the strong influence of anti-abortion politicians in North Carolina’s legislature, women seeking abortion within the state are required to wait for 72 hours after showing up for abortion care before they can actually receive either the procedure (if it’s a procedural abortion) or the medication (if it’s a medication abortion). Also minors —those under the age of 18— must either notify a parent, or otherwise go through a judicial bypass procedure. In judicial bypass, a judge reviews the case and decides whether the abortion seeker is mature enough to obtain an abortion without parental consent. In practice the judicial bypass route almost always leads to permission for the abortion. This is because, in order to decide that the young women is not mature enough to undergo an abortion, the judge would be implying that the young woman is mature enough to become a mother. This creates awkward dilemmas for the judges, so they usually allow the abortion.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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