National Partnership for Women & Families

Monthly Women's Health Research Review

Researchers assess effect of Utah's 72-hour mandatory delay law

Summary of "The longest wait: Examining the impact of Utah's 72-hour waiting period for abortion," Jessica Sanders et al., Women's Health Issues, August 5, 2016.

In 2012, Utah increased its mandatory delay law from 24 to 72 hours, becoming the first of five states -- including South Dakota, Missouri, North Carolina and Oklahoma -- to do so, according to Jessica Sanders of the University of Utah's Department of Obstetrics and Gynecology.

Utah's mandatory delay law requires women to attend an in-person visit with a provider at least 72 hours prior to the procedure, during which providers are obligated to share "medically inaccurate and out-of-date information regarding the mental and physical health consequences of having an abortion." The researchers added that the number of providers and clinics in the state has decreased over the last five years, from nine providers at four clinics in Salt Lake City in 2011 to seven providers at two clinics as of 2016.

For the study, the researchers assessed how extending the state's mandatory delay law affected "the proportion of women who obtain an abortion among those who completed the abortion information consultation and consent at the three largest family planning clinics in Utah." According to the researchers, those three clinics at the time of the law's enactment "served more than 90% of women obtaining procedures in the state." The researchers used the data, as well as additional information collected from women at one abortion clinic, to "provide insight into the impact of this legislative change on women seeking and receiving an abortion within the state of Utah."

Methods

The researchers used two assessments to inform their findings. The first assessment "is a retrospective chart review of three abortion clinics and eight associated clinic locations that offer abortion counseling and consent within the state of Utah." The researchers used the review "to compare the proportion of women returning for abortion procedures between two time periods: May 8, 2011, to May 7, 2012, which required a 24-hour [mandatory delay]; and May 8, 2012 to May 7, 2013, after the law requiring a 72-hour [mandatory delay]" went into effect.

For the second assessment, the researchers surveyed 307 women waiting for abortion care at one clinic in the state after the 72-hour mandatory delay law took effect. Survey participants answered "questions regarding lost wages, childcare costs, school days missed, distance traveled for counseling, distance traveled for procedure, transportation costs, and the ability to keep their abortion confidential."

The researchers also asked women to rate their "perception of the benefit or harm of the 72-hour [mandatory delay]" using a zero to 100 scale in which zero was "very helpful," 50 was "neither helpful, nor harmful" and 100 was "very harmful." In addition, the researchers asked participants how long they waited between calling the clinic and attending the mandatory counseling, as well as how long they waited between the mandatory counseling and obtaining an abortion. Participants also were asked "about prior awareness of the law and perceived value of the counseling visit."

Results

Based on the first assessment, the researchers found that 77 percent of the women who attended the information session returned for abortion care under the 72-hour mandatory delay law, compared with 80 percent of women under the 24-hour delay law. The researchers did not find any substantive statistical differences regarding women's demographic information.

For the second assessment, the researchers found that 80 percent of them "contacted the clinic for consent before 8 weeks after their last menstrual period." The researchers also found that while "72% of the women visited the clinic for the abortion information session within the first 3 days of calling the clinic, 63% of the women receiving an abortion reported that more than 7 days had passed since they visited the clinic for counseling and signed the consent form."

According to the assessment, 67 percent of respondents were not aware of the state's 72-hour delay before they contacted the clinic. Overall, 45 percent of women said "'the counseling provided valuable information and it was helpful to hear in person,'" while about 20 percent said "'making two trips to the health center, and waiting 72 hours in between, did not provide any benefits and made it harder to obtain an abortion.'"

Respondents provided an average score on the law's benefit and harm of 47.5, with "13% of women's scores ... in the bottom one-quarter, indicating that they felt the law was somewhat or very harmful."

According to the researchers, 62 percent of respondents "indicated the additional wait affected them negatively in some way." Of those who said they were negatively affected, "close to one-half had to take extra time off of work and 15 [percent] missed an extra day of school." In addition, 47 percent reported lost wages, 18 percent reported "excess childcare cost," 30 percent reported additional transportation costs and 27 percent said family members or friends experienced lost wages or additional expenditures. Further, about one-in-three women who reported being negatively affected by the law said "they had to tell someone they would not have told if the [delay] had only been 24 hours."

The researchers found that respondents traveled "a wide range of distances" to access abortion care: "About two-thirds of women could be counseled and consented within 25 miles from their home; however, only 42 [percent] could receive their abortion procedure within 25 miles." According to the researchers, "More than 10 [percent] of women traveled more than 100 miles from their home for their procedure."

Discussion

Utah's 72-hour mandatory delay law "was associated with a small but statistically significant decrease in the percentage of counseled women who returned for their abortion procedure (77%) compared with the percentage returning during the 24-hour [mandatory delay] (80%)," the researchers wrote. In addition, women who had an abortion after the law took effect "reported several burdensome aspects, including lost wages and increased expenses."

The researchers noted that while the first assessment did not examine "the reasons that women did not return for their procedure," a similar study found that 86 percent of Utah women returned for abortion care within three weeks of the initial consult under the state's 72-hour mandatory delay. According to the researchers, those findings also showed "that the law did not prevent abortions."

The researchers wrote that the second assessment also aligned with prior studies that "found mandatory counseling and [delays] burdensome to some patients." For example, other studies have "shown that states requiring two visits impose substantial time cost and travel expenses without having a significant effect on state[s'] abortion rates," increasing both the "direct and indirect cost of having an abortion." The researchers added that "states with mandatory [delays] that allow for the counseling material to be read over the phone, delivered via recorded message, or email rather than in person have been shown to reduce patient burden as compared with when the counseling must occur in person."

According to the researchers, the study's "wide range of harm-benefit perception ... emphasizes the complexity of individuals' understanding of the law and reminds us that this is not and should not be a one-size-fits-all solution for women seeking abortions." The researchers cited prior research "call[ing] for individualized patient counseling for women who are conflicted in their decision," adding that in-person consultations are not evidence based and remote counseling may "reduce barriers to accessing health care and improve overall patient care."

Noting that the 72-hour mandatory delay is one of several antiabortion-rights laws in Utah, the researchers wrote that while the extended delay "is a significant hurdle for many, it is challenging to quantify the additional burden of this restriction in the context of all other restrictions."

According to the researchers, the study "add[s] to existing literature on the hurdles that state-level legislation can create, many of which disproportiona[tely] impact women with fewer resources and those who must travel longer distances to access medical care." They called for additional research into the burden imposed by abortion restrictions, as well as "statewide education on medical legislation," given that many women were unaware of the 72-hour mandatory delay. The researchers also recommended "shar[ing] patient perspectives with policymakers to increase the awareness of how medical legislation plays out on real patients."