When It Comes To Abortion, Forcing Women To View Ultrasounds Is Just Unnecessarily Cruel, And It Doesn't Change Their Minds

Some very sketchy "studies" conducted by anti-abortion groups and the conservative rumor mill created the myth that "90% of women change their mind about abortion after viewing an ultrasound."

Jan 15, 2014 at 5:00pm | Leave a comment

10 states have laws on the books mandating ultrasounds before abortion procedures -- in three, the physician must describe the ultrasound as it is performed while the patient watches. This legal trend is the result of pushing from the right, on the grounds what women who see ultrasounds change their minds about getting abortions. 

Yet, recent research shows this isn't actually the case. Well, not entirely: a little over 1% of women change their minds about abortions after seeing ultrasound images, but the vast majority choose to go through with the procedure. So why is the right so bent on forcing patients seeking a private medical procedure to be tormented by their doctors?

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Photo: Loren Kerns

We have to go back a few years to start at the beginning of the story. It began, as Katy Waldman at Slate discusses, with two doctors in 1983 who noticed that expecting mothers eagerly looking forward to their pregnancies experienced ultrasounds positively, and that seeing the images enhanced the depth of bonding with the developing fetus. They speculated that perhaps women considering abortion might feel differently if they saw ultrasounds. 

Key there is the idea of speculation. They didn't run any controlled studies or conduct research of any kind. They just speculated. Their sample size was small, consisting oh, uh, two patients, but there's a chilling note in their discussion of the issue: 

Could ultrasound become a weapon in the moral struggle? Some communities and even one state have debated proposed legislation requiring that a picture of a human fetus be shown to a woman who requests an abortion. A court-ordered ultrasound viewing would be a potent (and unfair?) maneuver in the hands of those who represented the interests of the fetus in a dispute over proposed fetal therapy. Of course, ultrasound could be used to the same end by those who oppose abortion itself.

Even then, the potential of the ultrasound as a tool to manipulate patients was becoming apparent. Their commentary, some very sketchy "studies" conducted by anti-abortion groups, and the conservative rumor mill created the myth that "90% of women change their mind about abortion after viewing an ultrasound." That myth became the driving force behind the push for forced ultrasounds, because, you see, they were necessary for the patient's own good, as people clearly couldn't make rational decisions without all the information. Not when they have little lady brains.

That number was grossly wrong, though, in addition to being totally patronizing and offensive. A UCSF study indicated that viewing ultrasounds rarely influenced patients to decide not to go through with abortions, and this more recent study backs that up. 

In this case, the researchers looked at a patient population of 15,575 people, and broke them up into those with high, medium, and low decision certainty. 92.6% of the patients fell into the "high" category: they came in because they wanted abortions, they knew they wanted abortions, and they were confident in that choice. The remainder felt less sure. 

42.5% of the patients opted to see ultrasound images before proceeding, and in 98.4% of cases, they went ahead. By contrast, 99% of patients who didn't see their ultrasounds went forward, and 98.8% overall in the study got abortions after initiating a request for the procedure.

Looking at these numbers, we see that viewing ultrasounds was associated with a statistically significant, though very small, percentage of women choosing not to get abortions. But the numbers are more complicated of that. Firstly, women who viewed ultrasounds and decided not to get abortions were all from the medium to low confidence interval group, suggesting they felt conflicted about their abortions. They may have wanted more information about the procedure and the pregnancy, and the ultrasound may have been one among several pieces of information they considered before ultimately making the choice -- and the right to choose includes the right to continue a pregnancy -- not to get an abortion. 

What this study shows is not what the right will want to twist it to show. It doesn't say that patients who see ultrasounds change their minds about abortion. What it says is that people who are unsure about a medical decision should be supported with as much information as possible so they can make an informed choice that's best for them. 

Patients seeking abortions should be advised about all the options available to them, including detailed counseling, a description of the procedure, and viewing of ultrasound images. The key here is "advised," not "forced." If a woman doesn't want to know about fetal development or how the procedure will be performed, that's her right. If she wants to see the ultrasound before the procedure -- either to help her make a tough decision, or as a private rite of passage, or for some other entirely personal reason -- that's her right too. 

Informed consent is key for medical procedures, and I don't believe patients should ever be deprived of it. But I also believe that patients should be able to sift through information about what's available and decide if they'd like to hear more. Medical providers can say that more information is available without forcing it on patients.

Forcing patients to view ultrasounds is horrific and cruel. I'm always reminded of this heartbreaking story from Texas, where a woman who chose to get an abortion in her 20th week due to significant fetal anomalies and her inability to support the child was forced to listen to her doctor go over the sonogram. She describes being in the room with her husband, the doctor, and the nurse, none of whom wanted to be there, and how the nurse turned up the radio so she didn't have to listen to the legally mandated government script and description of the ultrasound. 

That patient deserved the right to choose: to choose if she wanted an abortion after discussing whether she wanted to go over all available options and what those options were. And to choose if she wanted to hear the developing fetus described. The fact that the government deprived her of that right on the slim chance that she might change her mind is revolting.

Patients who aren't sure and think viewing an ultrasound will help them should definitely be able to view it and ask questions. 

But no one, ever, should be forced to look at an ultrasound simply because a very small percentage of women choose not to abort after viewing an ultrasound: correlation is not causation, and clearly many factors were involved in their decisions. If the right is so darn determined to prevent abortions, providing condoms in schools would likely have a more meaningful effect that forcing patients to get ultrasounds -- but I'm just speculating.