National Partnership for Women & Families

Bad Medicine: How a Political Agenda is Undermining Abortion Care and Access in Louisiana

Issue Brief|May 2018Click to read: Bad Medicine: How a Political Agenda Is Undermining Abortion Care and Access in Louisiana

Across the country, politicians are enacting anti-abortion laws that ignore evidence and science and mandate how health care providers must practice medicine, regardless of the provider’s professional judgment, ethical obligations or the needs of his or her patients. Bad Medicine: How a Political Agenda is Undermining Abortion Care and Access, a 2018 report by the National Partnership for Women & Families, documents this trend.National Partnership for Women & Families. (2018, March). Bad Medicine: How a Political Agenda is Undermining Abortion Care and Access (3rd ed.). Retrieved 8 May 2018, from here. The report finds that a large majority of states have one or more of these “bad medicine” laws.

Louisiana is a key offender, with multiple abortion restrictions that bear no relationship to medical standards; undermine health care providers’ efforts to provide high-quality, patient-centered care; and take decision-making away from women. These restrictions punish women — particularly women of color and low-income women — who face multiple disparities and structural barriers that increase their likelihood of experiencing the harm caused by obstacles to abortion care.Blount, L. G., Yeung, M., & González-Rojas, J. (2015, April 30). Women of Color Leaders Call for a Change: End Barriers to Abortion Care. TruthOut. Retrieved 8 May 2018, from here; National Partnership for Women & Families. (2016, September). A Double Bind: When States Deny Abortion Coverage and Fail to Support Expecting and New Parents (p. 4). Retrieved 8 May 2018, from here. (For example, due to pervasive inequalities in access to quality health care, women of color are at a higher risk for unintended pregnancy — more than twice as much as white women.) Additionally, the one-two punch of racism and sexism against women of color helps create conditions of socioeconomic inequality, meaning financial barriers can be more difficult to surmount. Women of color who also experience other intersecting identities, such as insecure immigration status, disability and/or language barriers, among others, will necessarily experience discrimination and barriers based on these intersections. See, e.g., Desmond-Harris, J. (2017, January 21). To Understand the Women’s March on Washington, You Need to Understand Intersectional Feminism. Vox. Retrieved 8 May 2018, from here, (discussing the concept of multiple barriers — intersectionality — and how it operates in the lives of women of color in particular). It stands to reason that any obstacles to abortion will fall hardest on women of color, especially on women of color who are also low-income or experiencing other intersecting barriers to care.

In June 2016, the U.S. Supreme Court struck down two onerous Texas abortion restrictions in Whole Woman’s Health v. Hellerstedt. In that decision, the Court made clear that politicians are not allowed to make up facts in order to justify restrictions on abortion — unfortunately, a common practice in many places. The opinion strengthened the current legal standard used to determine whether abortion restrictions are unconstitutional by stating that restrictions must have enough benefit to justify the burdens on access they impose, and that states cannot rely on junk science.Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292, 2310 (2016). Recently, the well-respected, nonpartisan National Academies of Sciences, Engineering, and Medicine released a definitive report making clear the harms that medically unnecessary abortion restrictions cause for women around the country.National Academies of Sciences, Engineering, and Medicine. (2018). The Safety and Quality of Abortion Care in the United States. Washington, DC: The National Academies Press. Retrieved 8 May 2018, from here. Despite these clear legal and scientific strikes against bad medicine laws, Louisiana has not taken any steps to remove from its books laws that disregard evidence and interfere in a woman’s ability to obtain care.

This issue brief details how Louisiana politicians legislate bad medicine. It highlights examples of laws that undermine quality abortion care by interfering in the patient-provider relationship and advancing an ideological agenda that flouts medical evidence and scientific integrity.The examples discussed in this report are illustrative of the ways in which Louisiana restricts abortion care and undermines the practice of medicine. Sadly, Louisiana has imposed myriad restrictions on abortion access. To learn more about the breadth of restrictions, see Guttmacher Institute. (2018, January). State Facts About Abortion: Louisiana. Retrieved 8 May 2018, from here. Taken collectively or individually, these Louisiana laws create significant burdens on a woman’s access to abortion care.

Louisiana’s bad medicine laws include:

Biased CounselingMandatory provision of biased and inaccurate information. Under Louisiana law, providers are required to give women state-drafted materials that include biased and misleading information, such as a deceptive statement about the risk of abortion complications and the potential impact on future fertilitySee LA. REV. STAT. ANN. § 40:1061.17(B)(5) (2016); Louisiana Department of Health and Hospitals. (n.d.). Women’s Right to Know (pp. 21-22). Retrieved 8 May 2018, from here. But see, e.g., Lowit, A., Bhattacharya, S., & Bhattacharya, S. (2010). Obstetric performance following an induced abortion (p. 669). Best Practice & Research Clinical Obstetrics and Gynaecology, 24(2010), 667-682 (detailing various studies on abortion and fertility and finding little to no evidence that abortion has an effect on future fertility). and the implication that abortion is linked to breast cancer, despite numerous studies finding that no such link exists.See LA. REV. STAT. ANN. § 40:1061.17(B)(5); Louisiana Department of Health and Hospitals. (n.d.). Women’s Right to Know (p. 21). Retrieved 8 May 2018, from here. But see, e.g., Collaborative Group on Hormonal Factors in Breast Cancer. (2004). Breast cancer and abortion: Collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries. The Lancet, 363(9414), 1007-1016; American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. (2009, June; reaffirmed 2015). Committee Opinion No. 434, Induced Abortion and Breast Cancer Risk. Retrieved 8 May 2018, from here. (“[R]igorous recent studies demonstrate no causal relationship between induced abortion and a subsequent increase in breast cancer risk.”); American Cancer Society. (2014, June). Is Abortion Linked to Breast Cancer?. Retrieved 8 May 2018, from here. (“[S]cientific research studies have not found a cause-and-effect relationship between abortion and breast cancer.”) Additionally, the state-drafted materials discuss only negative emotional responses to abortion, including suicidal thoughts, depression or emotional distress — even though it is well documented that an “overwhelming majority” of women feel relief after, and do not regret having, an abortion.Louisiana Department of Health and Hospitals. (n.d.). Women’s Right to Know (pp. 21-22). Retrieved 8 May 2018, from here. But see, e.g., Rocca, C. H., Kimport, K., Roberts, S. C. M., Gould, H., Neuhaus, J., & Foster, D. G. (2015, July). Decision rightness and emotional responses to abortion in the United States: A longitudinal study (p. 2). PLoS ONE, 10(7); see also Rocca, C. H., Kimport, K., Gould, H., & Foster, D. G. (2013). Women’s emotions one week after receiving or being denied an abortion in the United States. Perspectives on Sexual and Reproductive Health, 45(3), 122-131; American Psychological Association Task Force on Mental Health and Abortion. (2008). Report of the APA Task Force on Mental Health and Abortion (p. 92). Retrieved 8 May 2018, from here. (“[T]his Task Force on Mental Health and Abortion concludes that the most methodologically sound research indicates that among women who have a single, legal, first-trimester abortion of an unplanned pregnancy for nontherapeutic reasons, the relative risks of mental health problems are no greater than the risks among women who deliver an unplanned pregnancy.”) Patients rely on their health care providers to give them accurate information based on medical evidence and their health needs, not on politicians’ ideology. When a state requires a health care provider to give information that is not based on scientific evidence or the interests of the patient, the patient can no longer trust that she is receiving the best possible care. That, in turn, diminishes the trust that is essential to the patient-provider relationship and undermines women’s ability to make informed medical decisions.National Partnership for Women & Families. (2018, March). Bad Medicine: How a Political Agenda is Undermining Abortion Care and Access (3rd ed.). Retrieved 8 May 2018, from here.

Ultrasound RequirementsDisplay and describe ultrasound mandate. In Louisiana, prior to an abortion, health care providers are required to administer an ultrasound, display the image and give a detailed, pre-scripted description of what the ultrasound image depicts — even when the woman objects.With narrow exceptions. LA. REV. STAT. ANN. § 40:1061.10(D)(2)(a) (2016). Providers must also make the fetal heartbeat audible.With narrow exceptions. LA. REV. STAT. ANN. § 40:1061.10(D)(2)(a) (2016). These mandates cause unnecessary delays, make care inefficient and directly undermine a provider’s ability to make health care decisions with a patient based on what is medically appropriate in her particular circumstances.See, e.g., National Academies of Sciences, Engineering, and Medicine. (2018). The Safety and Quality of Abortion Care in the United States (pp. 2-5, 2-27, 5-5). Washington, DC: The National Academies Press. Retrieved 8 May 2018, from here. The ultrasound mandate also flies in the face of medical ethics, which make clear that a patient’s decision to decline “information is ‘itself an exercise of choice, and its acceptance can be part of respect for the patient’s autonomy.’”Stuart v. Loomis, 992 F. Supp. 2d 585, 591 (M.D.N.C. 2014), aff’d sub nom. Stuart v. Camnitz, 774 F.3d 238 (4th Cir. 2014), cert. denied, 135 S. Ct. 2838 (2015) (quoting Committee on Ethics, American College of Obstetricians and Gynecologists. (2009, August; reaffirmed 2015). Committee Opinion No. 439, Informed Consent (p. 1). Retrieved 8 May 2018, from here.). It is a violation of medical standards to use a procedure to influence, shame or demean a patient.See, e.g., Committee on Ethics, American College of Obstetricians and Gynecologists. (2009, August; reaffirmed 2015). Committee Opinion No. 439, Informed Consent (p. 3). Retrieved 8 May 2018, from here. (“Consenting freely is incompatible with [a patient] being coerced or unwillingly pressured by forces beyond [her]self.”); American Medical Association. (2001). AMA Code of Medical Ethics, Principles of Medical Ethics. Retrieved 8 May 2018, from here. (“A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.”); American College of Physicians. ACP Ethics Manual (6th ed.). Retrieved 8 May 2018, from here. (“The physician’s primary commitment must always be to the patient’s welfare and best interests, whether in preventing or treating illness or helping patients to cope with illness, disability, and death. The physician must respect the dignity of all persons and respect their uniqueness. The interests of the patient should always be promoted regardless of financial arrangements; the health care setting; or patient characteristics, such as decision-making capacity, behavior, or social status.”) (“The physician must be professionally competent, act responsibly, . . . and treat the patient with compassion and respect . . . .”) (“Care and respect should guide the performance of the physical examination.”) Forced ultrasound, by definition, is not quality care.

Provision of information about fake women’s health centers. Louisiana law requires physicians to provide patients with a state-created list of “facilities” that “offer . . . ultrasounds free of charge,” but the list excludes any facility that “counsels, refers, performs, induces, prescribes, or provides any means for abortion.”LA. REV. STAT. ANN. § 40:1061.17(B)(5)(a), (D)(2) (2016). This requires physicians to share with patients a list of anti-abortion facilities, known as fake women’s health centers, which shame and lie to women to try to prevent them from accessing abortion care. Further, women who obtain an ultrasound at one of these facilities and choose to have an abortion are then required to have another ultrasound at the abortion clinic.

Mandatory DelaysMandatory delay in care and an extra visit to the clinic for no medical reason. Under Louisiana law, a patient must wait 24 hours after receiving a state-mandated ultrasound and biased information before being able to obtain abortion careLA. REV. STAT. ANN. § 40:1061.17(B)(3), (B)(5)(a); § 40:1061.10(2)(a) (2016) (describing that the provider must give the woman a copy of the state-created printed materials, inform the woman orally of specified information and perform the obstetric ultrasound at least 72 hours prior to an abortion). The 72-hour waiting period is not currently enforced pending litigation, but a 24-hour waiting period is still in place. June Med. Servs. LLC v. Gee, 280 F. Supp. 3d 849, 869 (2017). — despite the fact that such a delay serves no medical purpose and actually undermines the provision of care.Mandatory delays disregard a fundamental principle of quality care articulated by the National Academy of Medicine: care should be timely, reduce waits and delays, and be provided according to medical need and the patient’s best interests. Institute of Medicine. (2001, March). Crossing the Quality Chasm: A New Health System for the 21st Century (pp. 2-3). Retrieved 8 May 2018, from here. (The Institute of Medicine was renamed in 2015 to the National Academy of Medicine.) It is the patient, in consultation with her health care provider, who must make decisions about timing — not politicians. See also National Academies of Sciences, Engineering, and Medicine. (2018). The Safety and Quality of Abortion Care in the United States (p.2-26). Washington, DC: The National Academies Press. Retrieved 8 May 2018, from here. As a result of the mandatory delay, a woman seeking abortion care must make a medically unnecessary second trip to the clinic to receive an abortion. Most women seeking abortion care have already had at least one childGuttmacher Institute. (2018, January). Fact Sheet: Induced Abortion in the United States (p. 1). Retrieved 8 May 2018, from here. and thus may need to secure child care, transportation and time off work. Because Louisiana requires two trips to the clinic, women may have to do each of these things twice. The burden on many women is worsened by the fact that there is no law in Louisiana guaranteeing that private sector employees can earn paid sick days, and more than 45 percent of private sector workers in Louisiana cannot earn a single paid sick day.Institute for Women’s Policy Research & National Partnership for Women & Families. (2015, May). Workers’ Access to Paid Sick Days in the States. Retrieved 8 May 2018, from here. In other words, many women are forced to go without pay, and even risk losing their jobs, in order to make the trips required to obtain an abortion. As a result of these compounding factors, unnecessary delay requirements place the heaviest burden on rural, young and low-income people, exacerbating health disparities.See, e.g., Guttmacher Institute. (2018, January). Evidence You Can Use: Waiting Periods for Abortion. Retrieved 8 May 2018, from here; Joyce, T. J., Henshaw, S. K., Dennis, A., Finer, L. B., & Blanchard, K. (2009, April). The Impact of State Mandatory Counseling and Waiting Period Laws on Abortion: A Literature Review (p. 4). Guttmacher Institute. Retrieved 8 May 2018, from here, (noting that while mandatory delay and counseling laws affect women across economic and age spectrums, women who have resources — that is older, more educated and non-poor women — are better able to access services despite the restrictions); Texas Policy Evaluation Project. (2013, April). Research Brief: Impact of Abortion Restrictions in Texas (p. 1). Retrieved 8 May 2018, from here. (“These laws have had the greatest impact on low-income women and women in rural counties.”); American Civil Liberties Union. (n.d.). Government-Mandated Delays Before Abortion. Retrieved 8 May 2018, from here. In 2016, Louisiana enacted a 72-hour mandatory delay — triple the current wait time.2016 La. Sess. Law Serv. Act 97 (H.B. 386) (West). See also LA. REV. STAT. ANN. § 40:1061.17(B)(3), (B)(5)(a); § 40:1061.10(2)(a) (2016) (describing that the provider must give the woman a copy of the state-created printed materials, inform the woman orally of specified information and perform the obstetric ultrasound at least 72 hours prior to an abortion). The 72-hour waiting period is not currently enforced pending litigation, but a 24-hour waiting period is still in place. June Med. Servs. LLC v. Gee, 280 F. Supp. 3d 849, 869 (2017). This delay is not currently enforced due to ongoing litigation.

Medication Abortion RestrictionsBan on providing medication abortion via telemedicine. Louisiana prohibits the provision of medication abortion via telemedicineLA. REV. STAT. ANN. § 40:1061.11(A) (2016). , disregarding medical evidence demonstrating that it is safe and improves access. Telemedicine is a safe way to make health care more accessible, especially to individuals in rural or underserved areas.National Academies of Sciences, Engineering, and Medicine. (2018). The Safety and Quality of Abortion Care in the United States (pp. 2-10 to 2-11). Washington, DC: The National Academies Press. Retrieved 8 May 2018, from here. When medication abortion is administered via telemedicine, a woman meets in person with a trained medical professional at a health care clinic. She then meets via video conference with an abortion provider who has reviewed her medical records, after which the medication is dispensed to the patient.See Boonstra, H. D. (2013). Medication abortion restrictions burden women and providers — and threaten U.S. trend toward very early abortion (p. 20). Guttmacher Policy Review, 16(1), 18-23. Retrieved 8 May 2018, from here. Studies comparing medication abortion provided in person with those provided via telemedicine show equivalent effectiveness and rates of positive patient experience.See, e.g., Grossman, D., Grindlay, K., Buchacker, T., Lane, K., & Blanchard, K. (2011, August). Effectiveness and acceptability of medical abortion provided through telemedicine (p. 302). Obstetrics & Gynecology, 118(2), 296-303. As the American College of Obstetricians and Gynecologists (ACOG) has noted, the two types of visits are “medically identical.”Final Amicus Curiae Brief for Am. Coll. of Obstetricians & Gynecologists at 10, Planned Parenthood of the Heartland v. Iowa Bd. of Med., 865 N.W.2d 252 (Iowa 2015) (No. 14-1415).

TRAP LawsTargeted facility licensing requirements. Under Louisiana law, abortion clinics must meet unnecessary and burdensome facility licensing specifications that are similar to those required of ambulatory surgical centers (ASCs).See generally LA. ADMIN. CODE tit. 48, § 4401-4453 (2018). ASCs are designed for the delivery of complex and invasive surgeries historically provided in hospital settings.See, e.g., Brief for Amici Curiae Am. Coll. of Obstetricians & Gynecologists et al. in Support of Petitioners at 10, Whole Woman’s Health v. Cole, 136 S. Ct. 499 (2015) (No. 15-274), sub nom. Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016). In the Whole Woman’s Health decision, the Supreme Court found “considerable evidence .... that the statutory provision requiring all abortion facilities to meet all surgical-center standards does not benefit patients and is not necessary.”Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292, 2315 (2016). In its decision, the Court noted that “risks are not appreciably lowered for patients who undergo abortions at ambulatory surgical centers as compared to nonsurgical-center facilities.”Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292, 2315 (2016). (Quoting Whole Woman’s Health v. Lakey, 46 F. Supp. 3d 673, 684 (W.D. Tex. 2014).) It also found that patients “will not obtain better care or experience more frequent positive outcomes” at ASCs.Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292, 2315 (2016). The Court determined that abortion procedures were “safer than numerous procedures that take place outside hospitals and to which [the state] does not apply its surgical-center requirements,” and that the provision “provid[ed] no benefit when complications arise in the context of a [medication abortion].”Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292, 2315 (2016). Despite the decision, Louisiana still has similar requirements in place.

Hospital admitting privileges and related requirements. Until this restriction was blocked in April 2017 under the precedent set by the Whole Woman’s Health decision, Louisiana law required abortion providers to maintain admitting privileges with a hospital within 30 miles of where they perform abortions.LA. REV. STAT. ANN. § 40:1061.10(A)(2)(a) (2016). This law is currently enjoined. See June Med. Servs. LLC v. Kliebert, 250 F. Supp. 3d 27, 35 (M.D. La. 2017), appeal filed, June Med. Servs. LLC v. Caldwell, No. 17-30397 (5th Cir. May 12, 2017). Admitting privileges can be difficult or impossible for abortion providers to secure for reasons that have nothing to do with a provider’s skills.See, e.g., Brief for Amici Curiae Am. Coll. of Obstetricians & Gynecologists et al. in Support of Petitioners at 4, Whole Woman’s Health v. Cole, 136 S. Ct. 499 (2015) (No. 15-274), sub nom. Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016). Some hospitals only grant admitting privileges to physicians who accept faculty appointments.See, e.g., Brief for Amici Curiae Am. Coll. of Obstetricians & Gynecologists et al. in Support of Petitioners at 16, Whole Woman’s Health v. Cole, 136 S. Ct. 499 (2015) (No. 15-274), sub nom. Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016). Others require physicians to admit a certain number of patients per year before granting admitting privileges but, because abortion is such a safe procedure, abortion providers are unlikely to admit a sufficient number of patients.See, e.g., Brief for Amici Curiae Am. Coll. of Obstetricians & Gynecologists et al. in Support of Petitioners at 17, Whole Woman’s Health v. Cole, 136 S. Ct. 499 (2015) (No. 15-274), sub nom. Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016). Some hospitals only grant privileges to physicians who live within a certain radius of the hospital.Amici Curiae Brief of Pub. Health Deans et al. in Support of Petitioners at 17, Whole Woman’s Health v. Cole, 136 S. Ct. 499 (2015) (No. 15-274), sub nom. Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016). And hospitals that adhere to religious directives that run counter to established medical standardsSee generally Catholics for Choice. (2011, April). Memorandum from Catholics for Choice to Colleagues Regarding the Ethical and Religious Directives for Catholic Health Care Services. Retrieved 8 May 2018, from here. may refuse to grant privileges to abortion providers.See, e.g., Brief of Amicus Curiae Am. Pub. Health Ass’n in Support of Petitioners at 15, Whole Woman’s Health v. Cole, 136 S. Ct. 499 (2015) (No. 15-274), sub nom. Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016) (Citations omitted.). Moreover, admitting privileges requirements for abortion providers ignore the way modern medicine is practiced. Not only are emergency rooms required to admit and treat any patient with an emergent condition, but they rely on in-hospital doctors to provide care on-site — not outside physicians.See, e.g., Brief for Amici Curiae Am. Coll. of Obstetricians & Gynecologists et al. in Support of Petitioners at 18-19, Whole Woman’s Health v. Cole, 136 S. Ct. 499 (2015) (No. 15-274), sub nom. Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016). Louisiana’s law is blocked by a court order,June Med. Servs. LLC v. Kliebert 250 F. Supp. 3d 27, 35 (M.D. La. 2017), appeal filed, June Medical Servs. LLC v. Caldwell, No. 17-30397 (5th Cir. May 12, 2017). though the state is appealing that order in spite of the law’s clear unconstitutionality under Whole Woman’s Health.June Medical Servs. LLC v. Caldwell, No. 17-30397 (5th Cir. May 12, 2017).

Physician-only requirement. In Louisiana, abortion care — including medication abortion — can only be provided by a physician currently enrolled in or who has completed a family medicine or obstetrics and gynecology residency.LA. REV. STAT. ANN. § 40:1061.10(A)(1) (2016). A provision of this law, not currently enforced, would further limit the types of physicians that can perform abortions. This is despite evidence that advanced practice clinicians, such as nurse practitioners, certified nurse-midwives and physician assistants, can safely and effectively provide abortion care and do so in other states.Studies show that advanced practice clinicians can provide safe and effective abortion care. See Advancing New Standards in Reproductive Health. (2014, June). Health Workforce Pilot Project #171 Final Data Update (p. 2). Retrieved 8 May 2018, from here, (concluding that nurse practitioners, certified nurse midwives and physician assistants “can provide early abortion care that is clinically as safe as physicians”); see also National Abortion Federation. (2018). 2018 Clinical Policy Guidelines (p. 1). Retrieved 8 May 2018, from here. (“Abortion is a safe procedure when provided by qualified practitioners. . . . This category is intended to include physicians from various specialties as well as nurse midwives, nurse practitioners, physician assistants, registered nurses, and other health professionals.”). As of March 2015, advanced practice clinicians provide aspiration abortion care in California, Montana, New Hampshire, Oregon and Vermont. See Barry, D., & Rugg, J. (2015, March 26). Improving Abortion Access by Expanding Those Who Provide Care. Center for American Progress. Retrieved 8 May 2018, from here. This Louisiana law ignores the extensive training that advanced practice clinicians have in providing primary health care, managing chronic conditions and performing procedures that are more complex than abortion.See American Public Health Association. (2011, November 1). Provision of Abortion Care by Advanced Practice Nurses and Physician Assistants (Policy No. 20112). Retrieved 8 May 2018, from here. The law further ignores that leading medical organizations like ACOG recommend the pool of abortion providers be expanded to include “appropriately trained and credentialed advanced practice clinicians. ...”American College of Obstetricians and Gynecologists Committee on Healthcare for Underserved Women. (2014, November). Committee Opinion No. 613, Increasing Access to Abortion (p. 1). Retrieved 8 May 2018, from here. See also National Academies of Sciences, Engineering, and Medicine. (2018). The Safety and Quality of Abortion Care in the United States (pp. 3-7 to 3-9). Washington, DC: The National Academies Press. Retrieved 8 May 2018, from here.

Burial or cremation requirement for embryonic and fetal tissue. Under Louisiana law, providers must ensure that the embryonic or fetal tissue resulting from an abortion be cremated or buried, regardless of gestation or a patient’s individual circumstances.LA. REV. STAT. ANN. § 40:1061.25 (2016). Part of this provision is currently blocked in pending litigation. This law treats embryonic and fetal tissue differently than all other tissue resulting from medical procedures. This medically unnecessary requirement creates an additional burden on providers and increases cost without improving the quality of care. It could ultimately force providers to close if they are unable to arrange for affordable services. Moreover, it diminishes patient experience by mandating a non-medical ritual designed to shame and stigmatize the patient. This law is currently not in effect due to ongoing litigation.

Conclusion

Health care providers should not be forced to choose between following their medical and ethical obligations to their patients and following the law. However, that is exactly what is happening in Louisiana. Numerous laws in Louisiana directly interfere in medical decision-making and undermine the patient-provider relationship by usurping providers’ medical judgment and ignoring patients’ needs and preferences. It is time for those of us who oppose government interference in our most personal decisions to combat these bad medicine laws by standing up for medically accurate, patient-centered care that takes politics out of the exam room.

Below are five recommendations for state policymakers, the medical community, advocates and activists to join us in fighting back against bad medicine laws.

RejectReject. Lawmakers and everyone who makes policy should reject legislative and regulatory proposals that interfere in the patient-provider relationship; force providers to violate accepted, evidence-based medical practices and ethical standards; and undermine patients’ medical decision-making.

RepealRepeal. Lawmakers should repeal laws that were enacted based on politicians’ ideology rather than sound medical evidence, including biased counseling laws, ultrasound requirements, mandatory delay laws, restrictions on medication abortion and laws that place unnecessary licensing and credentialing requirements on providers.

ProtectProtect. Lawmakers should advance legislation that proactively prohibits interference in health care to ensure patients receive care that is based on medical evidence, not politics.



Speak OutSpeak Out. The medical community should speak out against political interference in health care, including requirements that force providers to violate their professional standards or deliver care that disregards accepted, evidence-based medical practices.

Rise UpRise Up. Activists and advocates should continue to call out harmful laws — and the deception behind them — every time we see them, and rally in support of proactive policies that expand access to high-quality, affordable abortion care and other reproductive health services. Together, we will keep fighting back until every woman in Louisiana is able to access the care she needs with dignity and without barriers.

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