Federal judge places injunction on parts of North Carolina's new abortion law

A federal judge placed a preliminary injunction Saturday on two parts of North Carolina's four-month-old abortion law, S.B. 20, which was passed over the veto of Gov. Roy Cooper by Republicans in the N.C. General Assembly.

A larger challenge to the law will continue, but provisions requiring surgical abortions to be performed in hospitals and limiting the prescription of abortion-inducing drugs will not be allowed to take effect.

"I’m encouraged that the court has struck down these restrictions on women’s reproductive freedom," Attorney General Josh Stein, who is a defendant in the case but opposes the law, said in a press release. "The law is not based in medical reality, and it was sloppily written. Women, not politicians, should be making these decisions."

Abortion-inducing drugs and intrauterine pregnancies

One of the provisions in the law requires a medical professional to document the "gestational age and existence of an intrauterine pregnancy" before administering an abortion-inducing drug.

But, the district court said, this requirement essentially prohibits abortions until well into the second month of pregnancy because physicians cannot determine whether a pregnancy is intrauterine without an ultrasound — which will not show an embryo until the fifth or sixth week of pregnancy.

The court said this provision is likely unconstitutionally vague, especially since another provision of the bill explicitly permits abortion until 12 weeks and because the potential criminal penalties for physicians were unclear. 

Much of this controversy comes from ectopic pregnancies — when an embryo grows outside of the uterus. Abortion medication generally does not affect ectopic pregnancies.

Often, ectopic pregnancies are difficult to diagnose, but S.B. 20 would likely prohibit a physician from prescribing abortion medication, even if the patient is at low risk for an ectopic pregnancy.

 "If the [legislative leaders'] interpretation of the statute is correct, then [physicians] will be prohibited from administering medical abortion drugs to a patient who wants an abortion early in pregnancy but whose ultrasound does not yet show the intrauterine location of the pregnancy, even if the patient is at low risk for an ectopic pregnancy," the decision said. "For such patients, the Act requires no blood test for ectopic pregnancy and no treatment for the possibility of an ectopic pregnancy."

Hospitalization for surgical abortions

Another provision that was put on hold by the court today required all surgical abortions to be done in a hospital because it likely violates the Equal Protection Clause of the 14th Amendment.

Surgical abortions are the only type of abortion legal in North Carolina after 12 weeks, and they are only allowed in cases of rape, incest fatal fetal anomaly or to save the life of the pregnant person. The procedures have routinely and safely been performed in outpatient clinics for years, and the procedure is the same in both settings.

In the last three-and-a-half years in North Carolina, the court found that less than 0.1 percent of surgical abortions performed by the physician plaintiffs required a transfer to a hospital, and all hospitalized patients were released in stable condition.

Both the American College of Obstetricians and Gynecologists and the American Public Health Association have said it is unnecessary for surgical abortions to always take place in hospitals, the decision said.

The court said the cost and extra burden placed on people who want to obtain an abortion after 12 weeks by requiring a hospital to perform the procedure may deter some people from obtaining an abortion within the legally required time limit.

Procedures used to perform a surgical abortion are also used for miscarriage management, and there is no requirement under the new law that miscarriage management must take place in a hospital. The court said the Republican legislators did not provide a rational basis for the difference in treatment for miscarriage and abortion patients.

"The legislature, through the intervenors, has offered no reason for this different treatment," the court said. "The harm to women pregnant as a result of rape or incest or who face life-limiting anomalies is obvious, as the differing treatment increases the costs and can delay treatment, which results in surgical abortions occurring later in the pregnancy when the risks to maternal health are greater."

The hospitalization requirement was set to go into effect on Sunday.

@ethanehorton1

@DTHCityState | city@dailytarheel.com

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