The Supreme Court of the United States (SCOTUS) decided the Dobbs versus Jackson Women’s Health Organization case on abortion last June, so we have been touring the US, state by state, region by region. We’re doing this here on The Pulse to compare and contrast the different situations, legal and otherwise, surrounding abortion. In many cases, this also affects access to pregnancy care, including care for spontaneous abortions (miscarriages) and stillbirths and care for ectopic pregnancies. Even fertility treatment is threatened in some states.
As for the Dobbs case that triggered the current situation, this case 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, 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 ballot measure in favor of keeping a guarantee of the right to choose in the Kansas state Constitution. There also are many states with laws extremely hostile to abortion, and with it reproductive health overall. Such states include Mississippi, Tennessee, Georgia, Alabama, Arizona, and Missouri.
When it comes to the state that we’re highlighting today, Utah, the Beehive State, the situation is complex. As of the writing of this post, in late October 2022, Utah is trying to join the group of states that prohibits abortion completely, the group that we mentioned includes Missouri, Arizona, and various others. When the SCOTUS issued the Dobbs decision at the end of June, a trigger law banning abortion went into effect, meaning a law that had been on the books, but that had not been in effect prior to Dobbs, on account of 1973 Roe versus Wade decision protecting abortion rights.
However, as of the writing of this post, abortion is still legal in Utah, on account of a temporary court injunction against the state’s abortion ban. The situation could change, and is likely to change, based on how things play out in the state court system, but for the time being, what is in effect, is not a ban on abortion, but an 18-week cutoff point. Up to a gestational age of 18 weeks, meaning 18 weeks past the first day of bleeding of the last menstrual period, you can receive abortion care in Utah. This means that you can have a medication abortion up to gestational day 77 (the end of the 11th week of pregnancy) and also that you can have a procedural abortion, at any point in pregnancy up to 18 weeks.
While a medication abortion means that you take two different medications on a certain schedule and that you do it at home, a procedural abortion is an abortion that involves instruments, so you must go to a clinic for that. One type of procedural abortion 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 up in Utah, if you are an abortion seeker under the age of 18 years. In such cases, one of your parents is required to give permission for the abortion. Additionally, one parent must be notified of the patient’s decision to have an abortion 24 hours before the abortion begins. A judge can excuse you from the consent requirement. To avoid the parental notification and permission requirement, the young woman can obtain a judicial bypass. Usually, parents are very supportive, but in those cases when they are not, the judicial bypass puts the case before a judge. The judge can 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.