By Hayleigh Colombo
(Lafayette, Ind.) Journal and Courier
LAFAYETTE, Ind. - The surge of ultrasound provisions making their way into abortion bills in recent years has been fodder for controversialDoonesbury cartoons and Saturday Night Livesketches.
It's also been the subject of bitter arguments in statehouses across the country, newspaper editorials and protests.
Now, Indiana will play out the fight over abortions on a fuzzy, black-and-white ultrasound screen.
What started as a debate last year about the legality of Planned Parenthood's Lafayette Health Center here to offer nonsurgical abortions to women in the form of a pill has turned into a plan in the Republican-controlled Indiana Senate to broaden the definition of an abortion clinic.
The bill also requires a woman seeking a nonsurgical procedure to end her pregnancy to undergo two ultrasounds, one before and one after.
If the bill, which an Indiana Senate committee passed Wednesday, becomes law, Indiana would shoot near the top of the list of U.S. states with strict ultrasound requirements.
Across the nation, ultrasound requirements in abortion bills have popped up more frequently and become stricter in recent years, said state issues manager Elizabeth Nash of the Guttmacher Institute in Washington, which studies reproductive health and policy around the world.
Among the strictest ultrasound requirements: In Louisiana, health care providers must perform an ultrasound before an abortion as well as display the image, according to the Guttmacher Institute. The same law is on the books in Texas.
Virginia legislators received national attention last year when they proposed legislation to require women to have an ultrasound before an abortion.
After critics called the bill "state rape," it was later weakened to remove a provision that would require a vaginal probe as part of the ultrasound.
"What we used to have are bills that required the offer of an ultrasound," Nash said. "Now, they've gone all the way to requiring an ultrasound or a transvaginal ultrasound, showing the image and having the woman listen to the fetal heartbeat."
With transvaginal ultrasounds a probe, or transducer, is inserted into the birth canal to view a woman's reproductive organs, according to the National Library of Medicine.
Indiana's bill doesn't specify that the required ultrasounds be transvaginal, but it likely would be necessary since an abortion pill is administered to women who have been pregnant for up to only nine weeks, according to Planned Parenthood. Transvaginal ultrasounds are said to be more effective at detecting a pregnancy in its early stages than abdominal, "jelly-on-the-belly" ultrasounds.
Ultrasounds are a normal part of abortion care. Providers regularly perform them at their medical discretion before a procedure.
And state statutes already set forth guidelines. Indiana code says that "before an abortion is performed, the pregnant woman shall view the fetal ultrasound imaging and hear the auscultation of the fetal heart tone ... unless the pregnant woman certifies in writing, before the abortion is performed, that the pregnant woman does not want to view the fetal ultrasound imaging."
But various officials have no consensus on what Indiana law now requires.
Betty Cockrum, president and chief executive of Planned Parenthood of Indiana, said she understands state law as requiring ultrasounds before surgical abortions, a position echoed by providers at other women's health clinics across the state.
But according to the Guttmacher Institute, Indiana law simply requires that providers offer ultrasounds to women.
The law is confusing and perhaps poorly written, Nash said. But that is how the institute has interpreted it.
Officials at the state Health Department and Attorney General's Office say they are not able to interpret statutes.
So, why have ultrasound mandates come to the forefront of abortion legislation?
The debate is about whether the language has been added out of medical necessity and in the interest of women's safety or to deter women from the procedure by making it, in some cases, uncomfortable and more costly.
"Ultrasound is a routine part of the preparation for an abortion, but it's not always medically necessary," Nash said. "There are reasons why you might not do any ultrasound. In every case, these bills are being promoted by those that want to ban abortion entirely. In recent years, it has really come to the attention of the public. We're starting to see push back."
Tippecanoe County Right to Life, the main antiabortion group in Central Indiana, supports the ultrasound requirement.
"Absolutely," said Connie Basham, an officer in antiabortion groups at both the local and state levels. "At this point, women's health is of the utmost importance."
Cockrum of Planned Parenthood said the proposal is improper.
"It is lawmakers again playing doctor and deciding that Indiana laws should direct doctors in their practice of medicine," she said. "To suggest that how and under what circumstances an ultrasound should be performed is inappropriate."
At the end of the day, said Joann Evers, president of the League of Women Voters of Greater Lafayette, what matters most is what Hoosier women's health care and what they think.
"Women are going to have to stand up and speak for themselves," she said.
(Lafayette, Ind.) Journal and Courier