Ultrasound, waiting-period requirements added to Wyoming abortion restriction bill

Wyoming’s bill to further regulate abortion clinics was amended late last week to require an ultrasound at least 48 hours before terminating a pregnancy.

House Bill 148 – Regulation of surgical abortions’ initial focus was on requiring clinics offering procedural abortions to be licensed surgical centers and for its doctors to have admitting privileges at a nearby hospital. Those requirements remain in the legislation, and discussion about them has stayed largely the same, too. 

Wyoming lawmakers passed an ultrasound requirement in 2017, but that only stated the patient had to be informed “of the opportunity to view an active ultrasound of the unborn child and hear the heartbeat of the unborn child if the heartbeat is audible.”

“​​Wyoming law currently makes ultrasound optional,” Rep. Chip Neiman (R-Hulett) testified in the Senate Labor, Health and Social Services Committee Wednesday. 

The new ultrasound requirement is a safety measure, according to Neiman, who is the House majority floor leader and the amendment’s sponsor. Ultrasounds can verify gestational age, viability and whether the mother has an ectopic pregnancy, he said.

“There are real protection issues here for the ladies that decide to do this,” he said.

The U.S. Food and Drug Administration warns against using common abortion-inducing medications if someone has an ectopic pregnancy or if the pregnancy is more than 70 days along. 

However, medical evidence for a universal ultrasound requirement is nonexistent, according to Kari White, executive and scientific director at Resound Research for Reproductive Health.

“While ultrasounds are often provided at the time of abortion, they aren’t needed,” she said. 

The American College of Obstetricians and Gynecologists stated in a 2022 review of medication abortions that gestational age can be accurately estimated without ultrasounds. It also noted that in a 1992 study, only about 1.3 per 1,000 pregnant women seeking abortion in the U.S. had ectopic pregnancies. 

Similarly, a 2020 study in the United Kingdom found that out of 11,381 women who sought an abortion, just 29 had either an ectopic pregnancy or “pregnancy of unknown location.” 

All but six had symptoms and/or had risk factors for ectopic pregnancies. Those final few — including three with ectopic pregnancies and three with pregnancies in an unknown location — had their condition initially identified by an ultrasound.

“The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases, but may provide false reassurance that a pregnancy is intrauterine,” authors wrote.

As of Wednesday, HB 148 had passed the House and the Senate Labor, Health and Social Services Committee — ultrasound requirements included. Next stop, the Senate floor. 

Why wait?

Rep. Landon Brown (R-Cheyenne) questioned the mandatory 48-hour wait during a House floor session last Thursday. 

“Is there a medical reason for the 48-hour waiting period, or is this: We want the individual to think for 48 hours and … we’re trying to guilt them into not doing it?” he asked. 

In response, Rep. Pepper Ottman (R-Riverton) — a board member for a crisis pregnancy center — said the wait gives people in “crisis” the “opportunity to get somewhere and get help.”

During Wednesday’s Senate committee hearing, Christine Lichtenfels — executive director of Chelsea’s Fund, an organization that supports abortion access — also had concerns about the wait. 

“It’s just so demeaning and insulting to women to suggest that we don’t make up our own minds,” she told the committee via Zoom. “We do not need government intruding into our decision-making process.”

“Who’s going to pay for the ultrasound?”

Sen. Fred Baldwin (R-Kemmerer)

A 2022 aggregation of U.S. studies about “mandatory waiting periods” for abortions found that the delays limited abortion options, increased costs and added other strains to those who have to travel for the procedures. At the same time, it found the delays didn’t cause a significant change in women’s choices. 

“There is no significant increase in decisional certainty where [a mandatory waiting period] is imposed, and more recent research reinforces the finding that [mandatory waiting periods] delay abortion and impose opportunity costs on women, which in turn have disproportionate impacts on poor women and those who live further away from clinics.”

Study authors also found that these delays likely go against international human rights protocols, which state abortion regulations shouldn’t “violate women’s and girls’ right to life, jeopardize their lives, subject them to physical or mental pain or suffering, discriminate against them, or arbitrarily interfere with their privacy.”

Ultrasound costs have also cropped up several times in discussion, first on the House floor and then in the Senate committee. 

“Is this an unfunded mandate?” asked committee chair Sen. Fred Baldwin (R-Kemmerer). “Who’s going to pay for the ultrasound?… It won’t be covered by insurance because it’s not medically indicated.”

Rep. Martha Lawley (R-Worland) pointed to Wyoming’s 10 “crisis pregnancy centers,” which offer free ultrasounds.

Some testimony before the Senate committee opposed making these anti-abortion, religiously affiliated centers the only source of affordable ultrasounds. They may not cooperate with abortion clinics that need proof of an ultrasound, noted Sharon Breitweiser, executive director of Pro-Choice Wyoming.

“There’s nothing in the law that requires them to even provide a written certification to the abortion provider,” Breitweiser said. “Many of the actual doctors and medical people may be reluctant.”

Crisis pregnancy centers are little regulated, so they may not have staff trained to identify ectopic pregnancies.

Last Friday, Rep. Mike Yin (D-Jackson) tried to amend the bill again by eliminating the 48-hour wait. The bill provides exemptions for procedures needed to save a woman’s life and treat ectopic pregnancy, but Yin said there are other complications that can progress dangerously in two days. 

“I want to make sure that if we’re going to pass bills like this, that we minimize the harms that we cause,” he said. 

His amendment failed, and the bill passed the House 53-9.

Lessons from other states

House Bill 148 shares provisions with laws passed in other states. Texas, for example, passed House Bill 2 in 2013, and the U.S. Supreme Court found it unconstitutional in 2016.

In the time that legislation was in place, the number of abortion clinics in Texas decreased from 42 to 19 with estimates that the number would sink even lower if the law wasn’t overturned. 

Ironically, White said, abortion clinics often had a hard time maintaining hospital privileges because they didn’t have enough patients who needed hospitalization.

“A provider may need … to see a certain number of patients in order to be able to maintain those privileges,” she said. “And one of the ironies is that abortion care is so safe, that they’re hardly ever going to be able to meet that threshold.”

Wyoming’s law is even more strict with that requirement, though, requiring privileges within 10 miles instead of the 30 miles required by the Texas law. 

The Center for Reproductive Rights was involved in the Supreme Court case that overturned Texas’ legislation, called Whole Woman’s Health v. Hellerstedt. The outcome made it clear that the positives lauded in passing the legislation were far eclipsed by the negatives, according to Elisabeth Smith, director of state policy and advocacy at the center. 

“All of these requirements are simply meant to create barriers that make it more difficult for people to access abortion care,” she said. 

That case was decided before the current Supreme Court overturned Roe v. Wade. 

Constitutional concerns 

“I need to know how many surgical abortion facilities are there in the state currently [or will be in place soon],” Rep. Dan Zwonitzer (R-Cheyenne) said on the House floor last Thursday. “Because if there is only one … I don’t think we need a third case before our highest court.” 

Zwonitzer was addressing the fact that, after an amendment to exclude hospitals, the bill would likely only affect one facility: Wellspring Health Access in Casper. In Wyoming, it’s illegal to pass “special legislation,” targeting a single specific entity. 

“When we really narrow it down to literally one building in the entire state, I believe we’ve created special legislation,” Yin said. 

Rep. Ember Oakley (R-Riverton) also had a concern about adding the ultrasound requirement that applies to all kinds of abortion into a bill that only mentioned “surgical abortions” in its title. 

“I think that goes beyond the title, which is prohibited,” she said. 

Article 3, Section 24 of Wyoming statute prohibits most bills  — outside of appropriation bills and general revisions of law — from “containing more than one subject, which shall be clearly expressed in its title.”

The larger House was unswayed by these concerns, though. 

Senate floor votes on HB 148 are expected in the coming days.