When Dr. Meera Shah meets a patient at her South Bend, Indiana, abortion clinic, she’s legally required to tell them that life begins at conception. She must tell them that fetuses can feel pain at or before 20 weeks. And she must tell them abortions carry many risks — up to and including death.
Then Shah immediately tells the patient that what she just said was, well, maybe not true.
“This idea of when life begins can be more complex for some people,” Shah tells patients. She adds, “Medically speaking, we know that pain may be perceived much later on in development” than 20 weeks.
As for whether abortion can kill you: “There’s the tiniest risk that you could bleed so much that it could result in death. However, this is incredibly rare,” Shah explains to patients. “Carrying a pregnant to term carries more risks than having an abortion.”
In 29 states, including Indiana, state law dictates what counseling a woman must get before an abortion. The idea is to make sure that she can give what’s called “informed consent,” essentially confirmation that she recognizes the purpose, risks, and benefits of abortion beforehand.
“You’re stuck between telling a patient a lie but being compliant with the law, or being truthful but then not being compliant with the law.”
But in practice, when people want abortions in conservative states, these laws often force providers to recite speeches or hand patients materials rife with inaccuracies and sweeping ideological claims. Providers are left struggling to find creative ways to obey both the law and their vow to do no harm.
“This interferes with medical ethics. This definitely feels really unethical for the state to require us to say these things,” Shah said. “It also interferes with the trust that I’m trying to establish between myself and the patient because the state’s having me say one thing, yet I’m telling them that it’s not entirely true.”
In some states, some of the counseling must be given orally; in others, it can sometimes be done through written materials that must either be offered or given directly to the patient.
Thirteen states want providers to tell patients about fetuses’ ability to feel pain, according to the Guttmacher Institute, which tracks abortion laws. (Fetuses lack the brain structures needed to process pain until at least 24 weeks into a pregnancy.) Four states require providers to inaccurately describe abortion’s risk to future fertility. (There is no link between safe abortion and infertility.) Four want them to incorrectly assert that abortion may be associated with a risk of breast cancer. (It’s not.) Eight have counseling that focuses on a woman’s possible negative feelings after getting an abortion. (A recent study of almost 1,000 women who’d gotten abortions found that, five years later, only 6% felt primarily negative emotions about it.)
Abortion rights advocates say these types of informed consent rules are “targeted regulations of abortion providers,” or “TRAP” laws, which impose medically unnecessary requirements on abortion clinics. Every provider who spoke with VICE News believes that they’re intended to shame women out of getting abortions.
“You’re stuck between telling a patient a lie but being compliant with the law, or being truthful but then not being compliant with the law and risking, sort of jeopardizing, all of your future patients,” explained Dr. Katie McHugh, who performs abortions in Indianapolis. If she doesn’t toe the line, McHugh knows she could face legal consequences that could leave her unable to help other people get abortions. Her actions could even imperil other providers, as abortion opponents could decide to use her as a cudgel to push for more restrictions on the procedure.
Like Shah, when McHugh talks to patients, she’ll rattle off the speech that the state wants her to say — then give her own medical advice, correcting statements she’d made just moments before. That 180-degree turn means that the informed consent process, meant to prevent confusion, frequently leaves patients bewildered.
“They don’t know what to believe,” McHugh said. “I’ve just told you something that’s not true. What about the part where I say, ‘This is a really safe procedure’? Was that true? Maybe that’s also a lie.”
By the time Nikiya Natale walked into an abortion clinic in Texas in 2013, she’d done enough research to know her providers might tell her inaccurate information. She was prepared when a nurse handed her a booklet with information about abortion and warned her, “A lot of it is not true, and it’s not medically accurate.”
“That was an intimidation effort, for sure, by the state.”
Under Texas law, abortion providers must offer that booklet, entitled “A Woman’s Right to Know,” to anyone who wants the procedure. It suggests that abortion is linked to infertility and breast cancer, and repeatedly refers to a fetus as a “baby.” And after reading it, Natale had her own opinion: “It’s just lies and junk. Just crazy stuff.”
Nothing in there swayed Natale from getting the abortion. “As soon as I saw that I had a positive pregnancy test, I knew exactly what I wanted to do,” she said.
Still, even with that preparation and that warning, Natale couldn’t shake the shame.
“They made it out to be such a big, huge ordeal that I was like, ‘Surely this is not good for me and this hurt me,’” she recalled. “I felt like something was wrong with my body, like I broke my body somehow because I chose to have this abortion, which is 100% false.”
Six states require that abortion patients be told that a medication-induced abortion can be “reversed.” In a typical medication abortion, patients take doses of two drugs several hours apart. However, proponents of so-called “abortion reversal” say that if a woman regrets her abortion after taking the first, she can skip the second and instead take the hormone progesterone.
The efficacy and safety of “abortion reversal” is still in question; the American College of Obstetricians and Gynecologists has dismissed the method as “not based on science.” There’s also evidence that not completing a medication abortion may be dangerous: A 2019 study on “abortion reversal” ended early after three of its 12 participants started hemorrhaging and landed in the ER.
When asked about that study, Utah Republican Rep. Keven Stratton, who sponsored his state’s abortion-reversal law, told VICE News that he thinks providers should still be required to tell patients about abortion reversal. If a provider then wants to inform patients about the study, Stratton said, they can do that, too.
“You have to give people the opportunity to have the information to make the choice,” Stratton said.
Five states mandate that providers inform their patients that personhood begins at conception, according to Guttmacher, even though the definition of “life” remains an unresolved question among biologists. “Abortion terminates the life of a whole, separate, unique, living human being,” declares a Kansas state-written booklet handed to abortion patients, before going on to repeatedly call the fetus an “unborn child.” In Indiana, Shah has to show her patients images of fetuses that are the same gestational age as the fetus they want to abort. And the images must be in color.
Other states urge women to consider continuing the pregnancy and then giving up their child for adoption. Last year, Monica Eary, a stay-at-home mom in Omaha, Nebraska, discovered that if she continued her pregnancy, her son would likely die within minutes of being born due to a congenital defect. If he lived, he’d need intensive medical care for the rest of his life — a prospect that Eary’s family could not afford financially or emotionally.
The day before Eary’s abortion, she sat in the bathtub and called her clinic to arrange the procedure. In the middle of the call, she had to listen to a state-mandated recording. It urged her to consider adoption and walked her through ways to get child support, she recalled.
Eary was infuriated.
“It made me understand how disconnected I think the people who are passing these laws are. I don’t think they understand or that they don’t even think about people in my situation and everything that goes along with it,” Eary said. “It feels like they’re rubbing your nose in it and they’re trying to take the control away… Like they’re the parents or something, and you’re their child and they’re scolding you and telling you, trying to talk you out of it.”
Informed consent requirements have been the subject of scores of lawsuits, but activists don’t expect a definitive ruling on their constitutionality anytime soon. In December, the Supreme Court left in place an informed consent law in Kentucky requiring doctors to show and narrate an ultrasound of the fetus, even if the patient doesn’t want to see or listen to it. Louisiana, Wisconsin, and Texas have similar laws in effect.
That requirement can be harrowing for patients. When Stephanie Gomez got an abortion in Texas in 2012, her doctor told her he was legally obligated to give her a “transvaginal ultrasound.” (Technically, Texas doesn’t specify what type of ultrasound patients must undergo. However, most women get abortions too early for accurate “jelly on the belly” ultrasounds, so providers usually need a transvaginal ultrasound to describe the fetus and play its heartbeat.)
Pregnant from a relationship she describes as abusive, Gomez was 18 years old and had never gone to the doctor before without her mom. She had no idea that a transvaginal ultrasound existed, let alone that it involved sticking a wand up her vagina.
Her doctor was also required to display the image, narrate the ultrasound, and make the fetal heartbeat audible. He had no choice, Gomez recalled him telling her, but she did: She didn’t have to pay attention.
“Do whatever you need to do, if you don’t want to look at it,” the doctor told Gomez. “You can close your eyes or you can look away… You can cover your ears, but I have to play the heartbeat.”
She took that advice, looking away from the screen and covering her ears during the ultrasound.
“I breathed this sigh of relief. I don’t know what would have happened to me if I had heard a heartbeat. That was an intimidation effort, for sure, by the state,” said Gomez. “I was already, like, so concerned with my religion and, you know, how I was going to exist afterward.”
Illustration by Nina Raj.