South Carolina: Abortion and Reproductive Care in the Palmetto State

Since the Supreme Court of the United States (SCOTUS) decided the Dobbs versus Jackson Women’s Health Organization case on abortion in June, we have been touring the US, state by state, region by region, comparing and contrasting the different situations, legal and otherwise, surrounding abortion. In many cases, this also affects the access to pregnancy care, including care for spontaneous abortions (miscarriages) and stillbirths and care for ectopic pregnancies and also fertility treatment. The case of Dobbs involved a Mississippi law prohibiting abortion after 15 weeks of pregnancy, meaning 15 weeks counting from the first day of bleeding of the last menstrual period. 6 out of 9 justices voted to uphold the Mississippi, but 5 of those six also joined onto a majority opinion written by Associate Justice Samuel Alito overturning the 1973 Roe v Wade decision that protected the right to choose. As a consequence of the Dobbs decision, the US is now a patchwork of drastically different legal situations. States with laws extremely hostile to abortion, and with it reproductive health overall, include Mississippi, Tennessee, Georgia, Alabama, Arizona, and Missouri. States, such as New York, Connecticut, Illinois, Oregon, New Mexico, Washington, North Carolina, are very supportive of abortion and reproductive rights, both for their own residents and those from out-of-state. Of such states, many protect the right to choose up to the point of fetal viability (24-26 weeks gestation) or close to that point. Additionally, there are states with strong majorities of anti-choice Republican politicians in the state legislatures and governors, because of either the state constitution or the court system. Such states include Kansas, Alaska, Montana, and Ohio. Kansas, despite its strong Republican leanings and active anti-abortion politicians and organizations, the people out and voted strongly on a ballet measure in favor of keeping a guarantee of the right to choose in the Kansas state Constitution.

Today’s focus, South Carolina, the Palmetto State is a state in which anti-choice activists and politicians threaten the right to choose. But, as of the writing of this post at the end of October, the right to choose still continues in the Palmetto State. During the summer of 2022, pro-choice and anti-choice forces fought things out in the South Carolina legislature. The South Carolina House passed a total ban on abortion, while the South Carolina voted against the bill. This means that things are very unstable and that the November 8 election (which likely will have occurred by the time that this piece is published could have dramatic consequences one way or another. For the time being, however, abortion is permitted in South Carolina up to a gestational age of 21 weeks and 6 days. This means 21 days and 6 weeks counting from the first day of bleeding of your last menstrual period. In the Palmetto state, you can have a medication abortion up to gestational day 77 (the end of the 11th week of pregnancy), or you can have a procedural abortion, at any point in pregnancy up to 21 weeks and 6 days. 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.

At some point during pregnancy, generally around the midpoint, suction is not enough to extract either a viable or inviable fetus. In such cases, the OB/GYN must use instruments to grab onto the fetus, or parts of the fetus. Such a procedure is known as a D&E, which stands for dilatation and extraction.

An additional restriction comes in if you are an abortion seeker under the age of 17 years. In such cases, either a parent or a grandparent of yours must give permission for you to have an abortion. If permission from a parent or grandparent is not possible, South Carolina has a judicial bypass option, in which a judge can allow the abortion. Technically, the judge may decide that the young woman is not mature enough to choose abortion, but this places the judge in the situation of implying that the young woman is mature enough to become a parent. Given this absurdity, most judges grant the bypass, but this is by no means a guarantee.

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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