Ongoing study shows ultrasounds do not have direct impact on abortion decision

Last week, Virginia became the latest state to consider mandating ultrasounds for all women who want an abortion. But as more states inject mandatory ultrasound policies into their abortion laws, a group of scientists is attempting to influence the debate with new research showing that ultrasounds, while useful and informative, do not directly influence a woman's decision to have an abortion, at least not in most cases. The research team has also found evidence of instances when anti-abortion pregnancy centers have misdiagnosed how far along a woman is in her pregnancy, potentially in an effort to delay or prevent an abortion.

The ultrasound movement

Ultrasounds have been at the forefront of the anti-abortion movement for the last few years. Lawmakers have introduced mandatory ultrasound laws in an increasing number of states; activists have featured fetuses “testifying” at capitols; and anti-abortion Congressman Cliff Stearns (R-Fla.) has proposed legislation to direct federal funding to crisis pregnancy centers for the purpose of purchasing ultrasound equipment.

According to the Guttmacher Institute (PDF), 19 states have some type of abortion-related ultrasound policy. In six of those states, all women wanting an abortion must first undergo an ultrasound. Last year the Texas Legislature went further than most states, not only mandating an ultrasound for every woman wanting an abortion, but forcing women to hear an explanation of the sonogram image, unless she is a victim of sexual assault or incest. Texas women who live up to 100 miles from an abortion provider have to wait at least 24 hours after they receive the ultrasound before they can get the abortion. Virginia lawmakers have also included this rule in their proposal.

At anti-abortion rallies and conferences throughout the country, leaders in the movement consistently talk about the power of ultrasounds — that they allow a pregnant woman to see a head and hear a heartbeat.

In a paper on ultrasound policy (PDF), Jeanne Monahan, the director of the Center for Human Dignity at the Family Research Council, suggests that ultrasound examinations might result in more desired pregnancies. The paper refers to statistics from studies conducted at anti-abortion pregnancy centers to assert claims like "eight in ten pregnancy resource centers report that 'abortion-minded' women decide to keep their babies after seeing ultrasound images," and "[a]ccording to an executive director of an Iowa pregnancy resource center, 90 percent of women who see their baby by ultrasound choose life." This argument is then used in legislative language (PDF) and floor debates.

Rep. Michele Bachmann (R-Minn.) introduced a federal mandatory sonogram bill last year and — citing the conservative policy group Focus on the Family — told Congress that "78 percent of women who see and hear the fetal heartbeat choose life." She was later corrected by Focus on the Family, which deemed her statement "inaccurate."

The anti-abortion group Americans United for Life has created model legislation for ultrasound policy (PDF) that, according to the organization, has influenced some of the recent state bills, including Texas'. In the model, Americans United authors assert: "[M]edical evidence indicates that women feel bonded to their children after seeing them on the ultrasound screen." The footnote attached to this claim points to a 1983 medical study that uncovered two cases in which women in the late first or early second trimester of pregnancy reported "feelings and thoughts clearly indicating a bond of loyalty toward the fetus."

But other than limited studies — many of them at crisis pregnancy centers — there is little research out there that defends the idea that viewing an ultrasound image is an abortion deterrent.

Tracy Weitz, assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the University of California - San Francisco, is the director of a university project called Advancing New Standards in Reproductive Health (ANSIRH). Later this year, ANSIRH will publish findings from two studies that look at how women are affected by viewing a sonogram before an abortion.

What the researchers have found so far is that viewing a sonogram is not an indication that a woman will cancel her scheduled procedure, regardless of what emotional response the sonogram elicits, Weitz told The American Independent. And that response can vary. Some women are happy to see the ultrasound because it makes their decision to abort more real, she said. Other women are sad to see the image, and still others have no emotional response.

Based on the results thus far, Weitz said she thinks women should be offered the option to have an ultrasound and view the image. However, she does not think it should be mandatory.

“Women do really need to be offered the option,” she said. “I don’t think people should be afraid that a woman [will want to see the ultrasound]. For some women, it’s an important experience.”

Preliminary results of Weitz’s study were presented in August 2010 at the UCSF/UC Hastings Consortium Lecture during a talk called "The Misuse of Science in Abortion Restrictions."

The data delivered was based on two small studies: one consisting of interviews with 20 women seeking abortions from two states, and another study consisting of interviews with ultrasound providers about their clinical practices.

In her August 2010 presentation, Weitz said, "Women do not have abortions because they believe the fetus is not a human or because they don't know the truth." She pointed out that 60 percent of abortion patients have already delivered a child, that most women have abortions because of the "material conditions of their lives."

The Patient Ultrasound Viewing Project is another Advancing New Standards in Reproductive Health study that documented ultrasound viewing practices among abortion providers in 17 states. This study consisted of in-depth interviews with ultrasound administrators at different types of abortion facilities. In addition to conducting interviews, researchers observed ultrasound practices in four clinical facilities and identified three standard ultrasound viewing models: (1) when sonograms are offered to everyone, (2) when sonograms are only shown upon request and (3) and when sonograms are shown in a "managed viewing."

A summary of the results concludes that the information an ultrasound provides is more important than the image itself, and that images should not be used to manipulate a woman's decision-making.

Do abortions harm women?

The ultrasound project was born out of a larger study Advancing New Standards in Reproductive Health has been conducting. In this more expansive project, the group is attempting to answer the question: Do abortions harm women?

The research has surfaced a few case studies in which women went to crisis pregnancy centers and were allegedly given false information about their gestational status. Weitz said the interviewers were led to believe that the misdiagnoses were intentional. In some instances, women underwent ultrasounds and were told they were further along than they actually were, and were thus ineligible for abortions. The period when a woman can get a legal abortion varies from state to state — in Mississippi, for example, state law bans abortions after 12 weeks — and many people are unfamiliar with the technicalities of abortion law.

The women in these case studies are among those in ANSIRH's longitudinal study who wanted an abortion but instead gave birth. Though the researchers are still studying the emotional and psychological impacts of abortion, at this point, Weitz believes that the coercive tactic — preventing abortion by lying — is harmful, and should be stopped.

“Yes, there is stigma, making [women] feel shame and guilt,” she said. “That probably doesn’t have any significant consequence. It’s not the first time she’s been shamed on this issue, and it’s not the first time she will be judged. But the stuff I’m more worried about is misinformation. That’s what we would consider unethical. It’s different from telling a woman that [abortion is] morally wrong."

Sonograms and CPCs

A recently updated report on U.S. pregnancy resource centers (PDF), published by the anti-abortion Family Research Council, indicates that more and more of these centers are being supplied with ultrasound equipment. The number of centers equipped with sonogram machines grew from 700 in 2008 to more than 1,000 in 2010, according to the report. In the U.S. there are more than 4,000 crisis pregnancy centers, many of them affiliated with one of three networks: Care Net, Heartbeat International, and the National Institute of Family and Life Advocates. These networks have a policy that only licensed medical professionals can operate ultrasound equipment.

The National Institute was founded in the early 1990s, initially to provide legal counsel to CPCS; later it became the first network to promote ultrasound technology as a way of legitimizing the centers. Much of the funding for these machines has come from two primary sources: Focus on the Family and the Knights of Columbus, both politically influential religious organizations.

What Weitz hopes is that more medical evidence is injected into the abortion rights debate — which she believes has become distorted by both liberal and conservative politics.

This sentiment played out recently when presidents from Americans United for Life and NARAL Pro-Choice of America were invited on Fox News to debate the recent appeals court ruling that upheld the majority of the Texas abortion law. Americana United’s Charmaine Yoest gave the common anti-abortion argument that viewing a sonogram will inform a woman's abortion decision, while NARAL's Nancy Keenan countered that a woman should have the option to have an ultrasound but should not be forced "against her will" to have the procedure.

“Both social movements make claims,” Weitz said. “In fact, the truth is somewhere in the middle.”

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