Abortion in North Carolina

Abortion in North Carolina is legal. Abortion related legislation existed in North Carolina by 1900, including a therapeutic exception.  Research was being done about abortion nationally using North Carolina data to derive to estimates in 1967. State Targeted Regulation of Abortion Providers (TRAP) laws were in place by 2013.[1] North Carolina abortion laws have been before the federal judiciary, including in March 2019 when U.S. District Judge William Osteen formally struck down North Carolina's life of the mother only 20-week abortion ban.[2]

The number of abortion-providing facilities in North Carolina, including freestanding abortion clinics, has declined over the years, with: 114 facilities providing abortion care in 1982, 86 facilities providing abortion care in 1992, 27 facilities providing abortion care in 2014 (16 of which were freestanding abortion clinics), and 26 facilities providing abortion care in 2017 (14 of which were freestanding clinics).[3][4] The total number of abortions in the state have generally declined over time, with a 36% decrease from 1980 to 2013.[5] There is an abortion rights activist community in the state, with women participating in #YouKnowMe movement and in #StoptheBans movement in May 2019. There is also an anti- abortion rights movement in the state, which has included an act of violence.

In 2017, Lindsay Beyerstein and Martyna Starosta directed "Care in Chaos," a short documentary that centered around the experiences of an abortion clinic director dealing with daily anti-abortion protesting outside of an abortion clinic in Charlotte, North Carolina.[6] This documentary won the category of "best documentary short" at the Nevada International Film Festival.[6]

Terminology
Main article: Abortion

The abortion debate most commonly relates to the "induced abortion" of an embryo or fetus at some point in a pregnancy, which is also how the term is used in a legal sense.[note 1] Some also use the term "elective abortion", which is used in relation to a claim to an unrestricted right of a woman to an abortion, whether or not she chooses to have one. The term elective abortion or voluntary abortion describes the interruption of pregnancy before viability at the request of the woman, but not for medical reasons.[7]

Anti-abortion advocates tend to use terms such as "unborn baby", "unborn child", or "pre-born child",[8][9] and see the medical terms "embryo", "zygote", and "fetus" as dehumanizing.[10][11] Both "pro-choice" and "pro-life" are examples of terms labeled as political framing: they are terms which purposely try to define their philosophies in the best possible light, while by definition attempting to describe their opposition in the worst possible light. "Pro-choice" implies that the alternative viewpoint is "anti-choice", while "pro-life" implies the alternative viewpoint is "pro-death" or "anti-life".[12] The Associated Press encourages journalists to use the terms "abortion rights" and "anti-abortion".[13]

Context
See also: Abortion in the United States

Free birth control correlates to teenage girls having a fewer pregnancies and fewer abortions. A 2014 New England Journal of Medicine study found such a link.  At the same time, a 2011 study by Center for Reproductive Rights and Ibis Reproductive Health also found that states with more abortion restrictions have higher rates of maternal death, higher rates of uninsured pregnant women, higher rates of infant and child deaths, higher rates of teen drug and alcohol abuse, and lower rates of cancer screening.[14]

According to a 2017 report from the Center for Reproductive Rights and Ibis Reproductive Health, states that tried to pass additional constraints on a women's ability to access legal abortions had fewer policies supporting women's health, maternal health and children's health.  These states also tended to resist expanding Medicaid, family leave, medical leave, and sex education in public schools.[15] According to Megan Donovan, a senior policy manager at the Guttmacher Institute, states have legislation seeking to protect a woman's right to access abortion services have the lowest rates of infant mortality in the United States.[15]

History

In 1967, a group of North Carolina-based researchers published estimates for the number of abortions performed in the United States; using data from North Carolina, they estimated that 699,000 induced abortions had been performed in 1955 and that the annual number had risen to 829,000 in 1967.[16]

Thousands of women came from out of state in 2015 to get abortions in North Carolina and Georgia. 14.5% of all abortions in Georgia that year were for out-of-state residents, while 7.5% of all abortions performed in North Carolina were performed for out-of-state residents.  This contrasted to neighboring South Carolina, where only 5.9% of abortions performed in the state involved out-of-state residents.[17]

One of the biggest groups of women who oppose legalized abortion in the United States are southern white evangelical Christians.  These women voted overwhelming for Trump, with 80% of these voters supporting him at the ballot box in 2016. In November 2018, during US House exit polling, 75% of southern white evangelical Christian women indicated they supported Trump and only 20% said they voted for Democratic candidates.[18]

Legislative history

By the end of the 1800s, all states in the Union except Louisiana had therapeutic exceptions in their legislative bans on abortions.[19] In the 19th century, bans by state legislatures on abortion were about protecting the life of the mother given the number of deaths caused by abortions; state governments saw themselves as looking out for the lives of their citizens.[19] In the late 1960s and early 1970s, Arkansas, Colorado, Georgia, Maryland, New Mexico, North Carolina and Oregon made reforms to their abortion laws, with most of these states providing more detailed medical guidance on when therapeutic abortions could be performed.[19]

In 2013, state Targeted Regulation of Abortion Providers (TRAP) law applied to medication induced abortions in addition to abortion clinics.[20] Nebraska and North Carolina had laws prohibiting abortions after 20-weeks.[21] This law was still in place in mid-2019.[22]

Judicial history

The US Supreme Court's decision in 1973's Roe v. Wade ruling meant the state could no longer regulate abortion in the first trimester.[19] U.S. District Judge William Osteen formally struck down North Carolina's 'life of the mother only' 20-week abortion ban in March 2019.  His judgement pushed the date of which abortions could be performed to the date of viability, which is later for many women.[23][24]

Clinic history
Number of abortion clinics in North Carolina by year.
See also: Abortion clinic

Between 1982 and 1992, the number of abortion clinics in the state decreased by 28, going from 114 in 1982 to 86 in 1992.[25] In the period between 1992 and 1996, the state ranked second in the loss of number of abortion clinics, losing 27 to have a total of 59 in 1996.[26] In 2014, there were 27 facilities that provided abortions of which sixteen were abortion clinics.[27][28] In 2014, 90% of the counties in the state did not have an abortion clinic. That year, 53% of women in the state aged 15 – 44 lived in a county without an abortion clinic.[29] In 2017, there were twenty-six total abortion-providing facilities (with fourteen total clinics including nine Planned Parenthood clinics of which five offered abortion services) in a state with a population of 2,335,631women aged 15 – 49.[30][31] Not all people who seek abortion care in North Carolina are residents of N.C., as clinics in cities near the borders attract people seeking abortion care from other states.[17]

State Restrictions on Abortion
  • Patients must receive state-directed counseling, read to them either in-person or over the phone at least 72 hours before their abortion procedure.[30] This state-directed counseling is mandated by the North Carolina Woman's Right to Know Act, passed in 2011. Information in this counseling includes: the name of the physician performing the abortion, medical risks associated with abortion care and with carrying the pregnancy to term, public and private state resources available for prenatal care including the location of a hospital within 30 miles that provides OB-Gyn care, that an ultrasound must be provided prior to the abortion and the patient has the right to view the ultrasound, parental support laws that require the father of the child to pay child support, alternatives to abortion such as adoption, that the patient is free to withdraw informed consent at any time, and the probable gestational age of pregnancy at time of the abortion.[32]
  • A patient is required to have an ultrasound before an abortion is performed.[30] The N.C. Woman's Right to Know Act originally contained a "real time view requirement" where physicians were required to provide a simultaneous explanation during an obstetric ultrasound and place ultrasound images in the view of the patient.[32] This part of the bill was struck down by a federal judge in 2014.[33]
  • Qualified physicians are the only parties legally able to perform abortions in North Carolina.[34][35][36]
  • Telemedicine for medication abortion is prohibited in North Carolina, and has been since 2013.[34] With the 2019-2020 Covid-19 epidemic, there has been increased focus by researchers, abortion rights activists and public health experts on the use of telemedicine for the provision of medication abortion nationwide.[37]
  • Health insurance coverage of abortion is prohibited for plans that are a part of the state's health exchange under the Affordable Care Act.[38] This provision has exceptions for cases of life endangerment, rape, and incest.[39] Public employees insurance plans are prohibited from covering abortion.[40] Public funding for abortion is also subject to these limitations.[41]
  • Parental consent is required for minors, those under the age of eighteen, to receive abortion care.[42] N.C. requires written consent from a parent or legal guardian, or for a minor to obtain a judicial bypass.[43] This law was held to be constitutional in Manning v. Hunt, 119 F.3d 254 (4th Cir. 1997).[44]
  • Sex-selective abortion is prohibited.[34]
  • North Carolina allows any provider or hospital with an opposition to abortion to opt out of the performance of abortion procedures through “conscience protections.” [34][45]
  • North Carolina banned abortions performed after 20 weeks gestation from 1967-2019.[46][44] Abortion pre-viability is protected by Roe v. Wade (1973). This ban was amended in 2015 to limit exceptions to this law to medical emergencies defined by G.S. 90-21.81(5)., where abortion must be performed in a licensed hospital by a board certified physician.[45] The passage of this amendment was a catalyst for a lawsuit by The Center for Reproductive Rights, the ACLU, and Planned Parenthood Federation of America, resulting in the N.C. federal case Bryant v. Woodall.[47] This law was struck down as unconstitutional on March 25, 2019 by U.S. District Court Judge William Osteen, Jr.[48] Abortions after 20 weeks are also required to be provided in a licensed hospital, rather than an abortion clinic. Abortion rights activists state that this law is unconstitutional based on the precedent established in the 1983 Supreme Court Case Akron v. Akron Center for Reproductive Health (462 U.S. 416).[49]
  • Article 11 Section 14-46.1. prohibits the sale of any products of conception resulting from an abortion or miscarriage.[45]
  • Abortion clinics in N.C. are required to be certified as an abortion clinic by a state license.[50] Clinics are subject to various regulations including required components,[51] temperature and air ventilation regulations,[52] and may be required to comply with ambulatory surgical center requirements.[53] This last provision is similar to Texas H.B.2, a law struck down by the 2016 Supreme Court Case Whole Women's Health v. Hellerstadt.[54]
  • The 1994 federal Freedom of Access to Clinic Entrances Act (FACE) makes it a federal crime to use force or the threat of force to prohibit anyone from entering clinics to obtain reproductive healthcare services.[55] North Carolina has a state corollary to this law, with misdemeanor charges for anyone who prohibits access to a healthcare facility, injures or threatens another person accessing healthcare services, or possesses a dangerous weapon at a private healthcare facility.[56]

Statistics

In the period between 1972 and 1974, the state had an illegal abortion mortality rate per million women aged 15 – 44 of between 1.1 and 1.9.[57] In 1990, 774,000 women in the state faced the risk of an unintended pregnancy.[25] In 2010, the state had 3 publicly funded abortions, of which were 3 federally funded and 0 were state funded.[58] The abortion rate in North Carolina increased between 2011 and 2014 by 3%.[28]

In 2013, among white women aged 15–19, there were  abortions 1110, 1380 abortions for black women aged 15–19, 310 abortions for Hispanic women aged 15–19, and 160 abortions for women of all other races.[59] In 2014, 49% of adults said in a poll by the Pew Research Center that abortion should be legal in all or most cases.[60] In 2017, the state had an infant mortality rate of 7.1 deaths per 1,000 live births.[15]

Number of reported abortions, abortion rate and percentage change in rate by geographic region and state in 1992, 1995 and 1996[26]
Census division and stateNumberRate% change 1992–1996
199219951996199219951996
South Atlantic269,200261,990263,60025.924.624.7–5
Delaware5,7305,7904,09035.234.424.1–32
District of Columbia21,32021,09020,790138.4151.7154.512
Florida84,68087,50094,0503030327
Georgia39,68036,94037,3202421.221.1–12
Maryland31,26030,52031,31026.425.626.30
North Carolina36,18034,60033,55022.42120.2–10
South Carolina12,19011,0209,94014.212.911.6–19
Virginia35,02031,48029,94022.72018.9–16
West Virginia3,1403,0502,6107.77.66.6–14
Number, rate, and ratio of reported abortions, by reporting area of residence and occurrence and by percentage of abortions obtained by out-of-state residents, US CDC estimates
LocationResidenceOccurrence% obtained by

out-of-state residents

 YearRef
No.Rate^Ratio^^No.Rate^Ratio^^
North Carolina 36,180 22.4 1992 [26]
North Carolina 34,600 21 1995 [26]
North Carolina 33,550 20.2 1996 [26]
North Carolina21,38510.817724,60512.420314.52014[61]
North Carolina23,06611.619127,63113.922917.52015[62]
North Carolina 23,168 11.6 192 27,138 13.6 225 16.8 2016 [63]
^number of abortions per 1,000 women aged 15–44; ^^number of abortions per 1,000 live births


Abortion rights views activities

Activism

In May 2019, women from the state participated in the #YouKnowMe movement. Amanda Payne of Durham was one of the women from the state sharing her story, saying, "I probably would have had to drop out of high school. [...] My boyfriend, who ended up being my husband, he had low-paying jobs. We didn't have anything. I don't think my life would be what it is today if I had continued that pregnancy."[64]

Protests

Women from the state participated in marches supporting abortion rights as part of a #StoptheBans movement in May 2019.[65]

Anti-abortion views and activities
Anti-Abortion Chalking Outside Time Warner Cable Center in 2012 in Charlotte.

Violence

An incident of anti-abortion violence occurred at an abortion clinic in Greensboro, North Carolina on March 17, 1991.[66]

Notes
  1. According to the Supreme Court's decision in Roe v. Wade:
    (a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgement of the pregnant woman's attending physician. (b) For the stage subsequent to approximately the end of the first trimester, the State, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health. (c) For the stage subsequent to viability, the State in promoting its interest in the potentiality of human life may, if it chooses, regulate, and even proscribe, abortion except where it is necessary, in appropriate medical judgement, for the preservation of the life or health of the mother.
    Likewise, Black's Law Dictionary defines abortion as "knowing destruction" or "intentional expulsion or removal".

References
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  4. Jones RK, Witwer E and Jerman J, Abortion Incidence and Service Availability in the United States, 2017, New York: Guttmacher Institute, 2019.
  5. Alvey, Jeniece; Bryant, Amy G.; Curtis, Siân; Speizer, Ilene S.; Morgan, S. Philip; Tippett, Rebecca; Hodgkinson, Jennifer C.; Perreira, Krista (November 2017). "Trends in Abortion Incidence and Availability in North Carolina, 1980–2013". Southern medical journal. 110 (11): 714–721. doi:10.14423/SMJ.0000000000000726. ISSN 0038-4348. PMC 5672819. PMID 29100222.
  6. "Rewire.News Award-Winning Documentary: Care in Chaos". Rewire.News. Retrieved 2020-08-11.
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  10. Brennan 'Dehumanizing the vulnerable' 2000
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  40. N.C. Gen. Stat. Ann. §§ 143C-6-5.5 (Enacted 2011).
  41. H.B. 397, 2003 Gen. Assem., 1st Sess. (N.C. 2003)
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  50. Gen. Stat. Ann. § 14-45.1(a) (Enacted 1967; Last Amended 1997); N.C. Admin. Code tit. 10A, r. 14E.0101(1).
  51. N.C. Admin. Code tit. 10A, r. 14E.0207
  52. N.C. Admin. Code tit. 10A, r. 14E.0206
  53. N.C. Gen. Stat. Ann. § 14-45.1 (Enacted 1967; Last Amended 2013), S. 353, 2013 Gen. Assem., Reg. Sess. (N.C. 2013)
  54. "Whole Woman's Health v. Hellerstedt".
  55. "Freedom of Access to Clinic Entrances (FACE) Act" (PDF).
  56. N.C. Gen. Stat. Ann. §14-277.2
  57. Cates, Willard; Rochat, Roger (March 1976). "Illegal Abortions in the United States: 1972–1974". Family Planning Perspectives. 8 (2): 86. doi:10.2307/2133995. JSTOR 2133995. PMID 1269687.
  58. "Guttmacher Data Center". data.guttmacher.org. Retrieved 2019-05-24.
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  60. "Views about abortion by state - Religion in America: U.S. Religious Data, Demographics and Statistics". Pew Research Center. Retrieved 2019-05-23.
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