In 2013, Indiana expanded its efforts to protect women and their unborn children from the harms of abortion, enacting a requirement that a physician examine a woman before providing abortion-inducing drugs and mandating the performance of an ultrasound before an abortion.
- Abortions may be performed at or after 5-months (i.e., 20-weeks) gestation only for “medical necessity.”
- Indiana prohibits partial-birth abortion.
- Indiana law requires that, at least 18 hours before an abortion, a woman receive information about the type of abortion procedure to be used, the risks of and alternatives to that particular procedure (including the risks of chemical abortion), the probable gestational age of the unborn child, the risks associated with carrying the pregnancy to term, and the name of the physician who will perform the abortion. Further, the woman must be told about state medical assistance benefits, the father’s liability for child support, and abortion alternatives.
- A 2011 law requires that informed consent information include the fact that human physical life begins when a human ovum is fertilized by a human sperm. Further, before an abortion, women must be informed before abortion that “objective scientific information shows that a fetus can feel pain” at or before 5 months (i.e., 20 weeks) gestation. This law is in litigation.
- Indiana requires an ultrasound before abortion. The image must be displayed unless the woman signs a form indicating that she did not desire to see the image. Further, the auscultation of fetal heart tone must be made audible, if possible, unless the woman signs a form indicating that she does not wish to hear the heart tone.
- A physician may not perform an abortion on a minor under the age of 18 without the written consent of one parent unless there is a medical emergency or the minor obtains a court order.
- All facilities performing surgical abortions must be licensed by the state Department of Health and meet comprehensive health and safety standards. Indiana also requires that post-first-trimester abortions be performed in a hospital or ambulatory outpatient surgical center.
- A law requiring clinics providing chemical abortions to meet the same patient care standards as facilities providing surgical abortions has been challenged in federal court.
- Only physicians licensed to practice medicine in Indiana may perform abortions. Abortion providers must have admitting privileges in the county where they provide abortions or in a contiguous county.
- The state has an enforceable abortion reporting law, but does not require the reporting of information to the Centers for Disease Control (CDC). The measure pertains to both surgical and nonsurgical abortions and requires abortion providers to report short-term complications.
- Every medical facility where abortions may be performed must be supplied with reporting forms provided by the state that require the reporting of, among other things, the post-fertilization age (of the pregnancy) and, if an abortion is performed at or after 5 onths (i.e., 20 weeks) gestation, the medical reason for the abortion.
- If an abortion is performed on a female who is less than 14 years of age, the physician who performed the abortion must transmit an informational form to both the state Department of Health and Department of Child Services within a specified time period.
- Indiana funds abortions for women eligible for public assistance when necessary to preserve the woman’s life or physical health or the pregnancy is the result of rape or incest. It further provides that neither the state nor any political subdivision of the state may make a payment from any fund under its control for the performance of an abortion unless the abortion is necessary to preserve the life of the pregnant woman.
- The Office of Women’s Health director and employees are not permitted to advocate, promote, refer to, or otherwise advance abortion or abortion-inducing drugs.
- The state prohibits insurance companies from offering abortion coverage within the state insurance Exchanges established pursuant to the federal healthcare law, except in cases of life endangerment, substantial and irreversible impairment of a major bodily function, rape, or incest.
- Indiana requires that a physician examine a woman before providing abortion-inducing drugs effectively preventing the dangerous practice of “telemed abortion.” The law also provides that the drugs cannot be administered past nine weeks post-fertilization unless the FDA has approved them for such use. Indiana offers “Choose Life” license plates, the proceeds of which benefit pregnancy resource centers and/or other organizations providing abortion alternatives.
Legal Recognition and Protection of Unborn and Newly Born:
- Under Indiana criminal law, the killing of an unborn child after viability is defined as a form of homicide.
- A person who causes the death of a child in utero while committing murder or felony murder may be sentenced to an additional fixed term of imprisonment that is equal to the advisory sentence for murder. This provision applies at any stage of gestation.
- An assault on a viable unborn child is a prosecutable crime.
- In addition, Indiana defines criminal assaults on a pregnant woman that result in miscarriage, stillbirth, or “damage to pregnancy” as an enhanced offense for sentencing purposes.
- The state allows a wrongful death (civil) action only when an unborn child is born alive following a negligent or criminal act and dies thereafter.
- The state has created a specific affirmative duty of physicians to provide medical care and treatment to infants born alive at any stage of development.
- The state defines substance abuse during pregnancy as “child abuse” under civil child welfare statutes.
- The state Department of Health has been directed to develop a system of registry for stillbirth information.
- Indiana bans human cloning for any purpose and prohibits funding of human cloning.
- While the state does not explicitly ban destructive embryo research, it does prohibit research on embryos created from ova initially provided for in vitro fertilization (IVF) purposes as well as experimentation on aborted fetuses. However, the state’s prohibition on experimentation on embryos created for use in IVF explicitly excludes fetal stem-cell research from its application.
- Indiana has established a public umbilical cord blood bank and an educational initiative to promote public awareness of the importance of donating. Participating facilities must offer patients the option of donating cord blood following delivery.
- The state has also directed the Board of Trustees at Indiana University to establish an adult stem-cell research center.
- Indiana prohibits the purchase or sale of human ova, but does not prohibit certain transactions between a woman and a qualified IVF clinic for certain expenses (e.g., earnings lost, travel expenses, medical expenses, or recovery time).
- The state does not otherwise regulate assisted reproductive technologies, but does prohibit gestational surrogacy contracts.
End of Life Laws:
- Assisting a suicide constitutes a felony.
- The state maintains a Physicians Order for Life Sustaining Treatment (POLST) Paradigm Program.
Healthcare Freedom of Conscience Laws:
Participation in Abortion and Contraception:
- A physician, hospital, facility employee, or staff member who objects on religious, moral, or ethical grounds is not required to participate in abortions.
- A private or religiously afﬁliated hospital is not required to permit the use of its facilities for the performance of an abortion.
- Indiana has a “contraceptive equity” law, requiring health insurance coverage for contraception. No exemption is provided for employers or insurers with a moral or religious objection to contraception.
Participation in Research Harmful to Human Life:
- Indiana currently provides no protection for the rights of healthcare providers who conscientiously object to participation in human cloning, destructive embryo research, or other forms of medical research, which violate a provider’s moral or religious beleif.
What Happened in 2013:
- Indiana enacted a measure, partially based upon AUL model language, requiring a physician to examine a woman before providing abortion-inducing drugs. The law effectively prevents the dangerous practice of “telemed abortion.” The law also provides that the drugs cannot be administered past nine weeks post-fertilization unless the FDA has approved them for such use and requires that informed consent information and state materials include information on the risks of abortion-inducing drugs.
- Indiana adopted an ultrasound requirement providing that the image must be displayed unless the woman signs a form indicating that she did not desire to see the image. Further, the provision mandates that the auscultation of fetal heart tone must be made audible, if possible, unless the woman signs a form indicating that she does not wish to hear the heart tone.
- Indiana adopted a measure requiring clinics providing chemical abortions to meet the same patient care standards as facilities providing surgical abortions.
- The state now allows midwives to provide the information required under the state’s informed consent law.
- The state also enacted legislation increasing the possible criminal penalties for an abortion performed in violation of state statutes.
- Indiana allocated $250,000 for “prenatal substance use and prevention” for pregnant women.
- Indiana considered legislation providing limited conscience protection for healthcare providers. The state also considered legislation offering or expanding protection for healthcare payers, but such legislation would not be enforceable against the so-called “HHS mandate” that requires nearly all health insurance plans to provide full coverage (without co-pay) of all “FDA approved contraceptives.”
Recommendations for Indiana:
Women’s Protection Project Priorities:
- Abortion Patients’ Enhanced Safety Act
- Parental Involvement Enhancement Act
- Components of the Child Protection Act related to evidence retention and remedies for third-party interference with parental rights
- Prenatal Nondiscrimination Act
- Joint Resolution Commending Pregnancy Resource Centers
Legal Recognition and Protection for the Unborn:
- Crimes Against the Unborn Child Act (to protect a child from criminal assaults regardless of gestational age)
- Unborn Wrongful Death Act
- Pregnant Woman’s Protection Act
- Promotion of ethical research alternatives
Healthcare Freedom of Conscience:
- Healthcare Freedom of Conscience Act