On July 1, the window in which to end a pregnancy in North Carolina narrowed. Senate Bill 20 criminalizes abortion after 12 weeks of gestation with few exceptions and places additional requirements on women seeking abortions.
Planned Parenthood South Atlantic, which operates nine health centers in North Carolina, and OB/GYN Dr. Beverly Gray, who provides abortions, filed a lawsuit in U.S. District Court challenging certain provisions of SB 20. However, their request for an injunction to keep the law from going into effect was denied. The overall lawsuit is ongoing.
Until July 1, Planned Parenthood’s Asheville location, the only clinic providing abortions in Western North Carolina, provided abortions through 14 weeks. Those who sought to terminate a pregnancy through 20 weeks were typically routed to health care facilities in Chapel Hill or elsewhere that could provide that service.
SB 20 bans most abortions after 12 weeks of pregnancy. In the case of rape or incest, abortion is allowed up to 20 weeks.
“We do expect the new barriers put in place may be insurmountable for some people,” Planned Parenthood South Atlantic spokesperson Molly Rivera tells Xpress. On June 30, two patients who were past 12 weeks of pregnancy were turned away from Asheville’s Planned Parenthood clinic in anticipation of the law going into effect the next day.
“We’re definitely already turning patients away in Asheville,” she says.
Violating the law would mean disciplinary action and, in some cases, felony penalties for abortion providers.
A year of restrictions
Previously, North Carolina was considered one of the Southern states with the fewest abortion restrictions. State law legalized abortion until fetal viability, which was generally considered to be around 24-26 weeks.
After the U.S. Supreme Court’s Dobbs v. Jackson decision in June 2022 overturned Roe v. Wade, Republicans in the General Assembly asked a U.S. District Judge to reinstate a ban on abortion after 20 weeks in August 2022. SB 20 followed in May, which was introduced and ratified in both chambers within 72 hours. According to reporting by The Associated Press, Gov. Roy Cooper vetoed the legislation May 16, but Republicans overrode that veto the following day.
SB 20 requires providers to schedule three in-person appointments. In-person counseling must be done at least 72 hours before the procedure. (Prior to July 1, nurses at Planned Parenthood’s Asheville clinic provided the required counseling over the phone, according to previous Xpress reporting.) “We do expect this extra in-person appointment [beforehand] to be an insurmountable barrier” to access, Rivera says. Patients may need to take more time off work and secure more child care, additional transportation to and from the appointment and potential travel accommodations if they’ve come long distances.
SB 20 also requires the provider to schedule a follow-up appointment seven-10 days after the abortion. Clinics already offer follow-up appointments if a patient wants one, but SB 20 mandates that a third in-person appointment is scheduled. The patient is not required to attend the third appointment.
Rivera says the condensed time frame to have an abortion, plus the additional scheduling of in-person appointments, could strain the capacity of Asheville’s clinic even further. The mandated appointments could impact the ability to provide other reproductive health care, including birth control, HIV services, testing for sexually transmitted diseases, transgender hormone therapy and the morning-after pill.
OB-GYN Dr. Elizabeth Buys, who practices at Mission Hospital, says she doesn’t consider the additional appointments now required by SB 20 to be medically necessary.
“[T]he criteria for a medical necessity typically would be that something medically would change based on that appointment,” Buys explains. “To have something ‘medically necessary’ means to me that if you don’t do something in that moment, then there’s a risk, or something you’re actually impacting that alters that medical condition.”
SB 20 has also changed access for terminating pregnancies resulting from sexual violence. Abortion is legal for up to 20 weeks in the case of rape or incest. Until Oct. 1, abortions for these circumstances may continue to be performed in clinics, Rivera explains. However, after Oct. 1, SB 20 mandates pregnancy terminations after 12 weeks can be done only in hospitals.
Planned Parenthood South Atlantic has requested an injunction to halt the additional restrictions for rape and incest. Rivera says a hearing is not yet scheduled.
Julie Mayfield, state senator for Buncombe County’s District 49, tells Xpress constituents who have contacted her office have been “overwhelmingly opposed to the bill.” She says she felt “a lot of anger and frustration” by the speed at which SB 20 was introduced to the General Assembly and subsequently passed.
“They know this is not a commonsense or mainstream bill,’” she says of Republicans in the General Assembly.
Tapped-out resources
Asheville’s Planned Parenthood clinic has seen a high volume of out-of-state patients since Dobbs v. Jackson, says Rivera.
The number of out-of-state patients at Asheville’s clinic fluctuates each week, she says, but it has risen as high as 80%. The statewide average was 15% before Roe was overturned.
Rivera notes that the abortion providers at Asheville’s Planned Parenthood clinic are part time, and they hold other jobs in the community as family physicians, OB/GYNs or fetal medicine providers. “We’re not able to provide abortion care every day of the week,” she explains. “What we’ve been able to do is schedule our providers for more appointments” by increasing the clinic’s hours.
Still, Rivera is concerned that increasing the clinic’s longer hours won’t meet the need. “There’s just no way that one health center in Asheville can see everyone who needs care in WNC and in these other states,” she says.
Mayfield is concerned that these abortion restrictions mean “we’re going to have a lot of horror stories about women who were not able to get the medical care that they needed, or that they wanted, and they sought other remedies.” Unsafe abortion is a leading cause of maternal death worldwide, according to the World Health Organization.
“Women are going to get abortions,” Mayfield says. “They will be legal, or they will be illegal. They will get them if they want them. … This bill is not going to change that. It’s just going to make it more dangerous by pushing it underground.”
‘There are unknowns’
Most abortions are performed before 12 weeks, according to data from the national Centers for Disease Control and Prevention. When an abortion occurs after 12 weeks, “often [it’s because of new] information around fetal development [such as] anomalies or birth differences that have been identified that may not make that fetus viable, which means able to live,” says Buys.
Some maternal health concerns aren’t identified until the second trimester, such as cardiac stressors like high blood pressure or impaired kidney function. An existing condition such as asthma also can “be fairly significantly changed during pregnancy,” Buys explains.
Also, some patients aren’t aware of a pregnancy in the first trimester, Buys says, explaining that some pregnancy-related “changes are vague or subtle, and patients aren’t aware.” Other times, a woman may be unaware she is pregnant because she was using contraception that affected her menstruation cycle.
Buys says patients have asked how the ban on abortion after 12 weeks may impact decisions made following the receipt of any test results. The cell-free DNA test, which screens for chromosomal abnormalities, has become common practice. However, “that test sometimes does not come back until after the 12-week mark,” she says.
Other information about fetal health can be revealed through test results that are available later in pregnancy. Maternal health providers can screen for 144 genetic diseases in the mother, Buys says. If a screening shows that a mother is a carrier for a rare genetic disorder, parents may seek to screen the father’s genetic makeup as well. That process can “take more time than 12 weeks,” Buys says.
Buys emphasizes that her patients hold a wide range of views and values around abortion. Yet regardless of individuals’ personal views, she says, “many of the patients that I take care of have an appreciation for the situation — there are unknowns that can happen to you and that you don’t know what you can do if you haven’t been in that exact situation.”
Editor’s Note: This is an ongoing story and will be updated with new developments.
Do you have more to add to this story? Contact the author at jwakeman [at] mountainx.com.
This country is being blasted by laws and rules made by the minority. I have never had an abortion, because I never needed one or wanted one. but a woman’s body is her own and a clump of cells does NOT a baby make. GOP cares not one whit about kids, they care about power. It’s waning and they are desperately clawing onto significance. Let go, won’t you? Your kind has destroyed the very fiber of our nation. I will not rest until you are gone, quiet, erased. I will do whatever I have to in the time I have left on this planet to make sure that happens.