Since August, we have been touring the United States, discussing the differing situations with respect to access to abortion and reproductive care in different states and regions. This is on account of the Supreme Court of the United States (SCOTUS) decision on the Dobbs versus Jackson Women’s Health Organization abortion case this past June. The case involved Mississippi’s Gestational Age Act, written to prohibit all abortions subsequent to 15 weeks gestation, with very few exceptions. The Dobbs decision ended up with six of the nine SCOTUS justices agreeing to uphold the Mississippi law, but five of those six justices also put their names on a majority decision to overturn the 1973 Roe v Wade decision. Written by Associate Justice Samuel Alito, that majority decision overturning Roe has resulted in a patchwork of different legal environments when it comes to abortion, reproductive rights, and access to reproductive health care. This is becomes each US state is responding differently. Various pro-choice states, such as New York, Connecticut, Illinois, Oregon, and Washington are extremely supportive of abortion rights to the point that they are welcoming abortion seekers from other US states, in some cases offering funding for travel and lodging to out-of-state abortion recipients, and in all cases are providing legal protection for abortion providers who might be targeted by authorities in the states of women who traveled to the host state.
Today, let’s discuss the Keystone State, Pennsylvania. This essentially is a pro-choice state, being the home of two major cities —Philadelphia and Pittsburgh— where pro-choice sentiment is strong. Consequently, the current legal situation in the Keystone State follows a Roe-like framework. This means that abortion generally the mother’s choice up to the point of fetal viability, meaning at least through 24 weeks of gestation. Beyond that, of course abortion can be permitted throughout the remainder of pregnancy if there is any health issue or some sort of fetal abnormality. In practice, the overwhelming majority of elective abortions occur during the first trimester, meaning during the first 12 gestational weeks.
Up to a gestational age of 77 days (11 weeks), abortion is often a medication abortion. You are given medications, which trigger expulsion of the products of conception. A physician or a mid-level practitioner then examines you to make sure that all products of conception have been expelled. Beyond 77 days, and sometime before that, termination of pregnancy involves a procedure, meaning that the provider works with instruments to achieve the abortion. 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.
Although Pennsylvania as generally abortion-safe, the state has a checkered history, related to the fact that the center regions of the state and various areas outside the urban areas are full of socially-conservative populations. Since 1982, this situation has influenced the Pennsylvania to the point that there are certain limitations resulting from a bill that was signed into law by the late Governor Robert Casey Sr., who was a Democrat, but opposed to abortion. His son, Senator Bob Casey Jr., is somewhat centrist when it comes to abortion. Though a Democrat and critical of the recent SCOTUS Dobbs decision that overturned Roe W. Wade, the younger Casey backed a Republican effort a few years ago to ban abortion from 20 weeks gestation onward. As for the late Governor Casey, the elder Casey, he played a pivotal role in the abortion issue during the 1980s and 1990s. The law that he signed in 1982, the Pennsylvania Abortion Control Act, was amended in 1988 and 1989, and then was challenged by Planned Parenthood of Southeastern Pennsylvania, because of various restrictions that the law placed on Pennsylvania women seeking abortions. This led to the famous SCOTUS decision of 1992 that we have discussed, Planned Parenthood of Southeastern Pennsylvania versus Casey.
In its amended form, the law mandated the following restrictions:
- Before undergoing an abortion, a woman had to provide “informed consent”, meaning that she needed to listen to information about abortion, information that was required to include possible, but rare, negative outcomes on the woman’s health, akin to the list of potential complications that you hear rattled off at the end of commercials for medications. She then would have to go home and wait at least 24-hours before returning for the actual procedure.
- All abortion facilities in Pennsylvania had to report themselves to the state
- Before undergoing abortion, a minor had to obtain informed consent from a least one of her parents, except in cases of “hardship” that a court would have to determine is present, in which case it could issue what’s called a judicial bypass. This meant that a minor who didn’t want to tell her parents about her pregnancy would have to explain her situation to a court, or to somebody working with a court. This requirement was designed to intimidate minors into backing off from their plans to terminate pregnancy.
- Before undergoing an abortion, married women were required to inform their husbands, except in cases of “medical emergency”. Along with deterring married women from terminating pregnancy, this requirement was intended to win political support from abortion opponents based on a rationale of paternal rights over the fetus. Also, by adding this provision to the law, Pennsylvania narrowed the definition of medical emergency to mean that the physician judges that the abortion is necessary “to avert [the mother’s] death or for which a delay will create serious risk of substantial and irreversible impairment of a major bodily function.”
Given the recent Dobbs decision authored by Justice Alito, it’s important to point out that Alito, during the era of the Casey decision, was one of three judges sitting on the Third Circuit Court of Appeals that reviewed the Planned Parenthood v Casey before it reached SCOTUS. Of those three judges, Alito was the only one who wanted to uphold the provision requiring married women to inform their husbands before obtaining an abortion. Fortunately, like Alito’s two colleagues on the appellate court, the SCOTUS of 1992 did not uphold that one provision of the Pennsylvania law.
But the other provisions were upheld. Consequently, today, if you appear at a clinic seeking an abortion, the providers are required to read you some silly statement about potential negative consequences of abortion and you’re required to think about it as you wait 24 hours before returning for your procedure, or medication. Also, young women who are underage either must involve a parent, or go through a judicial bypass procedure, in which a judge determines that she is mature enough to decide for herself to have an abortion. The judges typically will agree, since declaring a young women not mature enough to have an abortion would also imply that she is not mature enough to become a mother. Really, all of the provision of the law, drafted in the 1980s, were designed to make abortion inconvenient and thus possibly to deter women from ending their pregnancies. Don’t let yourself be deterred, however, if you do not wish to continue your pregnancy. Seek help from the various abortion providers throughout the Keystone State and the various organizations that you will find online that help women navigate through the abortion process.
Also, although generally we like to avoid politics here on The Pulse, the issue of abortion rights could not be more clear cut than it is in Pennsylvania in the coming election in November. In the race for Pennsylvania governor, for instance, the Republican candidate, Doug Mastriano, is such a staunch opponent of abortion rights that he has stated that women who receive abortions should be charged with murder. Meanwhile, the US Senate Republican candidate, Mehmet Oz —a doctor who for decades has promoted pseudoscience in the form of alternative healthcare— has avoided stating whether he would join an effort proposed by Senator Lindsey Graham to create a national ban on abortion after 15 weeks gestation. Please vote.