Planned Parenthood’s Ultrasound Schizophrenia
“Without performing diagnostic tests to ascertain the gestational age of the fetus, instead relying only on a bimanual pelvic examination, that he believed showed a twelve (12) week fetus, Dr. Abofreka began a termination procedure on Patient A. After applying suction several times, Dr. Abofreka realized that the pregnancy was greater than the twelve (12) weeks gestation he estimated on examination. He then stopped the procedure and performed a sonogram which showed the gestational age was approximately twenty-four (24) weeks…”[i]
On April 27, 2012, Planned Parenthood President Cecile Richards sent an email to supporters outlining what she described as “dangerous legislation” being pushed by “anti-women’s health lawmakers.” Specifically, she lamented that, “In Virginia and Texas, women seeking abortions are now forced by law to undergo ultrasounds.” However, a look at the facts shows that when it comes to requiring ultrasounds before abortions, Planned Parenthood suffers from some sort of schizophrenia.
Planned Parenthood routinely attacks ultrasound legislation and its criticisms have taken many forms, including claims that ultrasound requirements are “medically unnecessary,”[ii] focus on “limiting access to health care,”[iii] and “intimidate women.”[iv]
Each of these claims is false. But Planned Parenthood’s attempt to even argue them seems surreal and ridiculous considering that Planned Parenthood’s own internal policies require ultrasounds before abortions.
Adrienne Schreiber, an official at Planned Parenthood, told Commentary Magazine in February 2012, “That’s just the medical standard” to perform an ultrasound before an abortion.[v] “To confirm the gestational age of the pregnancy, before any procedure is done, you do an ultrasound.”[vi]
Ultrasounds serve the essential medical purpose of confirming the presence, location, and gestational age of a pregnancy. “The age and condition of the embryo or fetus is necessary to properly guide the physician in selection of the appropriate procedure to terminate the pregnancy.”[vii] Ultrasounds also help to diagnose ectopic pregnancies which, if left undiagnosed, can result in infertility or even fatal blood loss. The National Abortion Federation (NAF) lists “undiagnosed ectopic pregnancy” as one of “[t]he main complications” of chemical abortions.[viii]
In Texas Medical Providers Performing Abortion Services v. Lakey, the Fifth Circuit Court of Appeals upheld the 2011 Texas ultrasound law, finding that performing an ultrasound and checking for fetal heartbeat are both “routine measures in pregnancy medicine today” and viewed as “medically necessary” for the mother and unborn child.[ix]
Unfortunately, as the above example of Dr. Abofreka demonstrates, not all abortion providers have followed the medical standard. Pregnant women have experienced complications from abortion procedures due to the abortion provider’s failure to perform a timely ultrasound.[x]
Allowing women the opportunity to view their ultrasounds also serves an important role in providing informed consent, enabling women to exercise true choice. Upholding the Texas ultrasound law, the Fifth Circuit noted,
The point of informed consent laws is to allow the patient to evaluate her condition and render her best decision under difficult circumstances. Denying her up to date medical information is more of an abuse to her ability to decide than providing the information.[xi]
The disclosure of the ultrasound, the fetal heartbeat, and their medical descriptions are, as the Fifth Circuit ruled, “the epitome of truthful, non-misleading information.”[xii]
Planned Parenthood’s contrary suggestion, that ultrasound laws “intimidate” women, is wholly unsubstantiated, and even disproved by the research available. When asked if they would prefer having an ultrasound examination before an abortion, at least one study found that the majority of women would choose to have an ultrasound and simultaneously view the image.[xiii] Another study found that most women (86.3%) who chose to view the ultrasound found it a positive experience.[xiv]
When ultrasound legislation was being considered in Texas and Virginia, the bills’ opponents waged another line of attack to raise a media firestorm. They claimed these bills required “invasive” trans-vaginal ultrasounds.
Planned Parenthood Trust of South Texas, an affiliate operating thirteen clinics in San Antonio, Kingsville, Harlingen and Brownsville, stated “This outrageous piece of legislation requires that women seeking an abortion must receive an invasive trans-vaginal ultrasound…”[xv]
First, this claim is patently false. The legislation did not dictate what type of ultrasound must be performed.[xvi] The Virginia bill was even amended to make this explicitly clear.
But in all the “outrage,” nobody questioned—or even seemed to notice—Planned Parenthood’s own documented use of trans-vaginal ultrasounds before early abortions.
A study on early abortions[xvii], published in 2003, surveyed 113 abortion providers including 74 Planned Parenthood affiliates that performed abortions, and found these clinics routinely use vaginal ultrasounds before an early abortion.[xviii]
- “Vaginal ultrasound was always performed before the early surgical abortion at 59 (89%) sites, under certain conditions at 11 (16%) sites, and never at one (1%) site.”[xix]
- “Vaginal ultrasound was very common before the medical abortion, with 37 (92%) sites reporting that they always performed it. However an additional 2 (5%) sites did vaginal ultrasound before the procedure only under certain conditions and 1 (3%) site never did.”[xx]
The researchers found the fact that “[a]lmost all sites offering early medical abortion always performed a vaginal ultrasound before and after the abortion” was “consistent with common practice in the U.S.”[xxi]
The study even credits “vaginal ultrasonography” as one reason that “early abortion” has become what it considers a “safe and practical option.”[xxii] Notably, the National Abortion Federation (NAF), which describes an early abortion as a “critical time for diagnosis of ectopic gestation,” and states that “providers must remain vigilant to detect this complication,” explains that “experienced sonographers using a transvaginal probe” are an important means to rule out an ectopic pregnancy.[xxiii]
Highlighting another oddity in attacking the legislation for being “invasive,” Planned Parenthood’s Adrienne Shrieber noted to Commentary Magazine, “But if she’s uncomfortable with a transvaginal ultrasound, then she’s not going to be comfortable with an equally invasive abortion procedure.”[xxiv]
In her April 2012 email, Cecile Richards wrote that “Do you know what the main difference is between Planned Parenthood and our opponents? We trust women.”
But Planned Parenthood’s ultrasound schizophrenia proves just the opposite.
Planned Parenthood’s requirement that its own abortion patients undergo ultrasounds is evidence that it understands the clear, essential medical purpose ultrasounds serve. So why does Planned Parenthood oppose efforts to make an important medical standard the legal one? Perhaps Planned Parenthood fears that a woman’s fully-informed choice may lead her out of the abortion clinic. That would explain why Planned Parenthood does not want to be legally obligated to offer women certain information, including the opportunity to view her ultrasound.
Planned Parenthood does not trust women.
[i] Abofreka v.Virginia Bd. of Med., 2007 WL 2301727 (Va. Ct. App).
[ii] Knox College Students Learn about GYT Campaign, Attacks on Women’s Health Care, Planned Parenthood Illinois Action (April 17, 2012), http://plannedparenthoodillinoisaction.blogspot.com/2012/04/empowering-young-people-knox-college.html (last visited Sept. 14, 2012).
[iv] Maryland Legislation, Planned Parenthood of Maryland,http://www.plannedparenthood.org/maryland/maryland-legislation-28761.htm (last accessed Sept 14, 2012).
[v] Alana Goodman, Planned Parenthood Says it Won’t Do Abortions Without Ultrasounds, Commentary Magazine, Feb. 22, 2012, available athttp://www.commentarymagazine.com/2012/02/22/planned-parenthood-abortions-ultrasounds/ (last visited Sept. 14, 2012).
[viii] See Early Options: A Provider’s Guide to Medical Abortion, National Abortion Federation, (2010), http://www.prochoice.org/education/cme/online_cme/m2complications.asp (last visited Oct. 7, 2012).
[ix] Texas Med. Providers Performing Abortion Serv. v. Lakey, 667 F.3d 570, 579 (5th Cir. 2012).
[x] See, e.g., Abofreka v.Virginia Bd. of Med., 2007 WL 2301727 (Va. Ct. App). The substandard care Dr. Abofreka provided included, “Without performing diagnostic tests to ascertain the gestational age of the fetus, instead relying only on a bimanual pelvic examination, that he believed showed a twelve (12) week fetus, Dr. Abofreka began a termination procedure on Patient A. After applying suction several times, Dr. Abofreka realized that the pregnancy was greater than the twelve (12) weeks gestation he estimated on examination. He then stopped the procedure and performed a sonogram which showed the gestational age was approximately twenty-four (24) weeks…” See also Consent Order, Before the Virginia Bd. of Med., 2007, available athttp://www.dhp.virginia.gov/Notices/Medicine/0101023297/0101023297Order05182007.pdf (last visited Sept. 11, 2012).“The patient stated to Dr. Kim that her last menstrual period had been [six to eight weeks prior]. Dr. Kim stated that she performed a pelvic examination and believed the patient to be eight weeks pregnant.” After beginning the abortion, Dr. Kim realized the patient was much further along, estimating her pregnancy to be at 24-26 weeks. The following day, via sonogram, the gestational age was recorded at 26 4/7 weeks.”
[xi] Texas Med. Providers Performing Abortion Serv. at 573.
[xii] Id. at 578.
[xiii] See Bamigboye et al., Should women view the ultrasound image before first-trimester termination of pregnancy? 92 So Afr Med J. 6, 430 (2002).
[xiv] See Wiebe et al., Women’s perceptions about seeing the ultrasound picture before an abortion, 14 The Eur J. Contracept & Repro Health Care 2, 97 (2009).
[xv] See Texas 82nd Legislative Session Update, Planned Parenthood Trust of South Texas, available at http://www.plannedparenthood.org/south-texas/legislative-update-37028.htm (last visited Sept. 14, 2012).
[xvi] See Tex. Health & Safety Code § 171.012 amended by H.B. 15, 82nd Leg., Reg. Sess. (Tex. 2011)available at http://www.legis.state.tx.us/tlodocs/82R/billtext/pdf/HB00015F.pdf#navpanes=0 (last visited Sept. 14, 2012); See also Va. Code Ann. §18.2-76 amended by H.B. 462, 2012 Reg. Sess. (Va. 2012) available at http://lis.virginia.gov/cgi-bin/legp604.exe?ses=121&typ=bil&val=HB462 (last visited Sept. 14, 2012).
[xvii] Abortion prior to 6-7 weeks since the last menstrual period.
[xviii] Janie Benson et al., Early abortion services in the United States: a provider survey, 67 Contraception 287 (2003), available at http://www.lifenews.com/wp-content/uploads/2012/02/ultrasoundstudy.pdf (last visited Sept. 14, 2012).
[xix] Id. at 289.
[xx] Id. at 290-291.
[xxi] Id. at 293.
[xxii] Id. at 287.
[xxiii] See Early Options: A Provider’s Guide to Medical Abortion, National Abortion Federation, (2010), http://www.prochoice.org/education/cme/online_cme/m2complications.asp (last visited Oct. 7, 2012).
[xxiv]Alana Goodman, Planned Parenthood Says it Won’t Do Abortions Without Ultrasounds, Commentary Magazine, Feb. 22, 2012, available athttp://www.commentarymagazine.com/2012/02/22/planned-parenthood-abortions-ultrasounds/ (last visited Sept. 14, 2012).