Eleven other states have legislation pending. If all of the measures pass, more than half of the states will have laws governing ultrasound exams before abortions. “I think we’re in the middle of a wave of ultrasound bills,” said Elizabeth Nash, a policy analyst with the Guttmacher Institute, which studies reproductive health.
In most states that require ultrasounds, as will be the case in Virginia, women must wait at least 24 hours between abortion counseling and the procedure and make at least two trips — one for the counseling and ultrasound, and another for the abortion.
Providers say scheduling of those trips — and not the ultrasound — has been the most cumbersome and costly effect of the law.
“In the majority of cases, these are working moms who have to cancel two days of work, arrange transportation twice and arrange child care twice,” said Amy Hagstrom Miller, who operates five clinics in Texas.
In Texas and Virginia, women who live more than than 100 miles from a provider would not have to make two trips.
“That is the practicality obstacle,” said Rosemary Codding, director of the Falls Church Healthcare Center. Those barriers prevent access to medical care, and then “you’re promoting illegal abortions somewhere else,” she said.
Despite the controversy over what type of ultrasound would be required in Virginia’s bill, both abdominal and vaginal ultrasounds are, in fact, used by most abortion providers. They are the most accurate tool for determining the development stage of a fetus, doctors said.
“It’s pretty much common practice,” said Willie Parker, a doctor who performs abortions in the Washington region and Philadelphia.
Abdominal ultrasounds are the most common. The vaginal ultrasound is mainly used in the earliest stages of pregnancy — between four and six weeks — when an abdominal ultrasound is unlikely to produce an image.
Only about one-third of abortions are performed at six weeks or less, according to 2005 data from the U.S. Centers for Disease Control and Prevention.
Providers need to know how far the pregnancy has progressed to ensure that an abortion is taking place within a state’s legal time frame, that medically appropriate methods are being used, and to rule out ectopic pregnancies.
Sixty percent of abortions are done in the first nine weeks of pregnancy, when medication abortions are most effective, doctors said. More than 88 percent of the 1.2 million abortions performed each year in the United States occur in the first trimester of pregnancy. Most doctors will not perform them beyond 22 or 24 weeks.