December 9, 2010 — Although most women seeking medical abortions receive an ultrasound, a recent study suggests that this step is not medically necessary and could serve as a barrier to the procedure, Reuters reports. Medical abortion, which involves taking a dose of the drug mifepristone followed by misoprostol, can be performed in the U.S. within nine weeks of a woman’s last menstrual period. The drugs are about 97% effective. While there are no official guidelines that women should first receive ultrasounds, the practice is common because it is the most precise way to determine how long a woman has been pregnant.

The study — published in the British Journal of Obstetrics and Gynecology — explored whether a woman’s estimate of her last menstrual period and a physical exam would be adequate to determine her eligibility for a medical abortion early in pregnancy. For the study, Gynuity Health Projects researchers examined data on 4,484 women seeking medical abortions at one of 10 family planning clinics, including eight operated by Planned Parenthood. The women provided the date of their last period and received a physical exam and an ultrasound.

The study found that based on the reported date of the last period and a physical exams alone, a medical abortion would have been performed beyond nine weeks for only 1.6% of the women, all of whom but one were within the 11th week of their last period. Studies show that medical abortion is still effective with no increased risk of complications at 11 weeks.

Possible Implications

Lead researcher Hillary Bracken of Gynuity said the study’s findings suggest that abortion providers and physicians who do not have ultrasound equipment can still “feel safe” in offering medical abortion. She added that this could also expand access to medical abortion in rural areas of the U.S. and developing countries, where ultrasounds are not available.

Eliminating ultrasounds before medical abortions also could reduce cost barriers. According to Planned Parenthood, ultrasounds in the U.S. range from $350 to $650 or more depending on what tests or exams are performed (Norton, Reuters, 12/8).

A Missouri law that includes a number of new abortion restrictions was enacted Saturday. The legislation became law last month after Missouri Governor Jay Nixon (D) avoided signing the law by citing a provision in the Missouri constitution that allows a bill to become law without the governor’s signature, thereby avoiding a direct endorsement of the law.

The new law expands upon Missouri’s’ existing abortion restrictions by instituting a 24-hour waiting period prior to the procedure, requiring abortion providers to present patients with printed materials detailing the risks of the procedure as well as the physiological characteristics of an unborn fetus, and mandating that a qualified professional “discuss the medical assistance and counseling resources available, advise the woman of the father’s liability for child support, and provide information about the Alternative to Abortion Program.” The law also includes a provision that would ban abortion coverage in the state’s soon-to-be-created health insurance exchange mandated by the new federal health reform package.

Additionally, the law requires women to have the opportunity to view an “active ultrasound” and hear “the heartbeat of the unborn child, if the heartbeat is audible.” It also requires women to be told that a fetus may be able to feel pain. An abortion cannot be performed until women seeking the procedure complete and sign a checklist that states she has been fully informed of all required information.

According to the Courthouse News Service, every woman who seeks an abortion procedure must receive a pamphlet that prominently displays the following language: “The life of each human being begins at conception…Abortion will terminate the life of a separate, unique, living human being.”

According to the Kansas City Star, the only clinics that offer abortion services in Missouri are located in Columbia and St. Louis. Those who advocated against the new laws argued that because women in Missouri often must travel significant distances to obtain an abortion, the new requirements increase the cost (in both money and time) to gain access to the procedure.

Louisiana Governor Bobby Jindal signed three bills on Tuesday instituting new restrictions on abortion rights in the state. The first law requires women seeking abortions in Louisiana to undergo an ultrasound prior to the procedure. There will be no exceptions for victims of rape or incest Opponents remain concerned that the ultrasound requirement, an expensive procedure that may not be available at free clinics, will increase costs and make obtaining abortion services more difficult for women.

The second new law excludes providers from medical malpractice coverage for elective abortion procedures, reports the Associated Press. The third anti-choice bill signed by Governor Jindal yesterday prevents insurance providers in the new federal health insurance exchange from covering abortions.

Last month Governor Jindal signed House Bill 1370, a law that gives Louisiana’s health secretary greater power to revoke abortion clinic licenses when there are health or safety concerns. According to Associated Press the law allows the health secretary to immediately suspend a clinic’s license in the case of urgent health or safety risks. The health secretary is also granted broader discretion to refuse the renewal of existing licenses, as well as to deny new licenses to abortion clinics.

Under the guise of obtaining informed patient consent, this new law requires doctors to withhold pregnancy termination until an ultrasound is performed.

The new statute requires the person performing the ultrasound to describe the dimensions of the fetus, whether arms, legs and internal organs are visible and whether there is cardiac activity. It also requires the doctor to turn a screen depicting the ultrasound images toward the woman to see them.

“We’ve had patients leave the ultrasound room in tears because of what they had to hear. But no patient at the clinic had yet canceled an abortion after hearing a description of the fetus” said Linda Meek, executive director of Reproductive Services of Tulsa.

Meek said requiring women to listen to a description can be traumatic, she said, especially for rape and incest victims and women with fetal abnormalities or whose pregnancy threatens their own life.

The law states that either an abdominal or vaginal ultrasound, whichever gives the best image of the fetus, must be done. Neither the patient nor the doctor can decide which type of ultrasound to use, and the patient cannot opt out of the ultrasound and still have the procedure. In effect, then, the legislature has mandated that a woman have an instrument placed in her vagina for no medical benefit. The law makes no exception for victims of rape and incest.

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