What We Are Missing in the Trans-vaginal Ultrasound Debate


Everyone please step away from the ledge. The public discourse about mandated trans-vaginal ultrasounds for abortion patients is completely out of control—among both abortion rights opponents and abortion rights supporters. The facts are slim and distorted on all sides. It is time for a more thoughtful discussion on the issue.

Let’s start with reviewing what these new laws usually require. The laws are often based on model legislation developed by American’s United for Life (AUL), a law and policy advocacy organization that seeks “legal protection for human life from conception to natural death.”  The laws mandate that abortion providers must let women view a real-time ultrasound image of their fetus prior to consenting to an abortion. That image must be as good as technology will allow and the doctor, who is the same doctor who will subsequently perform the abortion, must perform the ultrasound, describe the image to the woman in detail, and let her listen to the fetal heart. All this must occur at least 24 hours prior to the abortion. Because trans-vaginal ultrasounds provide higher quality images at earlier gestational stages, these laws by definition require abortion providers to perform trans-vaginal ultrasounds. Generally, women are not allowed to opt out of these requirements, although there are now a few very limited exceptions in some state laws.

Because the idea of sticking a probe in a woman’s vagina against her will is appalling to the general listener, abortion rights supporters have focused on this single aspect of the laws as a way to generate public outrage. Advocates refer to the required ultrasounds with phrases such as “medical rape.” The problem is that the indignation generated is almost exclusively focused on the mandatory nature of the probe—not on what is actually wrong with the law.

To step back, the stated purpose of the ultrasound laws is to give a woman information about her pregnancy that might persuade her to opt against having an abortion. AUL explains the logic: “Medical evidence indicates that women feel bonded to their children after seeing them on the ultrasound screen. Once that bond is established, researchers argue, a woman no longer feels ambivalent toward her pregnancy and actually begins to feel invested in her unborn child.” In all the high-pitched hype about “medical rape,” no one is critiquing this stated justification for the laws. And there is much to critique.

First, the purported medical evidence is speculative. In the above excerpt from AUL’s argument, each sentence includes a footnote to a 1983 editorial in the New England Journal of Medicine that hypothesized that ultrasound viewing could dissuade women from having an abortion. However, the authors of the editorial based their conjecture on experiences with two—yes, only two—pregnant women who viewed their ultrasounds. This hardly counts as medical evidence.

Second, to date, no peer-reviewed empirical data has supported this proposition that viewing an ultrasound image discourages women from abortion. In fact, what limited information does exist suggests that women seeking abortions have a range of experiences associated with viewing their ultrasound and any mind-changing occurs in a complex context that may or may not include ultrasound viewing along with other factors.

In work my colleagues and I conducted at the UCSF ANSIRH program, we discovered that many women who voluntarily choose to view their ultrasound image find viewing helpful—and sometimes it even confirms their decision to have an abortion. Those who oppose abortion rights might be shocked to find that their efforts to ensure viewing actually help women choose abortion and resolve conflict over their decisions. This is true for women at all stages of gestation.

Both supporters and opponents of abortion rights get another thing wrong: they misunderstand standard abortion practice. The use of trans-vaginal ultrasounds is routine among abortion providers. When I started this work three decades ago, pregnant women often had to wait until they were seven or eight weeks pregnant before providers felt comfortable performing an abortion—they needed to wait that long to confirm a pregnancy and its placement. With advances in ultrasound technology—specifically the ability to conduct trans-vaginal ultrasounds—providers can now verify an intrauterine pregnancy as early as 4 weeks. Women no longer have to wait through weeks of pregnancy symptoms and distress before having a desired abortion. Trans-vaginal ultrasound is a useful tool and shouldn’t be maligned by abortion rights supporters seeking to make a quick exaggerated political point.

Please don’t get me wrong. Mandated ultrasound viewing regulations are bad laws—just not for the reasons that make the nightly news. Rather, it is the minutiae of the requirements, ones activists may feel are too hard to explain, that lead them and the media to focus on the elevated hype about probe penetration.

Let’s consider the minutiae of these laws and the significant problems they pose. To start, the policy requires that a physician perform the ultrasound at least one day in advance of the procedure and that this physician is the same physician who performs the abortion. There are several problems with this requirement. One, this type of mandate is contrary to the way health care is generally provided. The truth is that ultrasounds are routinely performed by competent non-physician staff in the abortion setting. There is no evidence that this way of providing care is unsafe or unsatisfactory.

Two, these mandates increase the costs of abortion. Requiring the physician to be present in the clinic on two consecutive days drives up the cost of abortion for the women seeking them. In most states, low-income women have to come up with between $500 and $1000 in cash to pay for an abortion. For a woman living at or below the poverty level this is equivalent to a month’s income.  Our research finds women take this money from other expenses like rent, utilities and food. In all other aspects of health care, the trend is to use less expensive personnel to perform some patient procedures to both drive down health care costs and save higher-skilled personnel for more complicated activities. The reverse trend in abortion care is deliberate and is meant to make women opt out of abortion, not because of some information the ultrasound gives them, but because abortion is no longer affordable. It is disappointing that state medical associations that vigorously fight efforts by state legislators to tell them how practice medicine have been virtually silent on these ultrasound requirements.

The next aspect I’ll consider here is the inability of women to opt out of aspects of ultrasound viewing; patients have to view and listen to a description of their ultrasound image. This is an intrusion into patient’s rights to control the course of her health care. Research from other health care services finds that patients’ sense of control has implications for long-term outcomes. It is not about whether women can refuse a probe (which may be medically necessary) but whether they can refuse to watch and listen—mandates that serves no medical purpose.

In contesting these mandates, however, abortion rights supporters need to be very careful about claiming that women will be traumatized by being forced to view their fetal ultrasounds.  We have no data that these outcomes occur. Yes, it is likely that some women will have negative reactions when they view an image they do not want to, but it may not be because of the content of those images. It is probable that the negative emotions are caused by the lack of agency they are allowed over what happens in their clinical encounters. Ultrasound is ubiquitous in American culture, so the images are neither foreign nor shocking for most women. We know, however, that women resent not being allowed to decide how they are treated by their health care providers. Indeed, objections to this kind of paternalism are what sparked the beginning of the women’s health movement in the first place.

We must also consider the unintended consequences of current pro-choice framing of these laws. Women who enter an abortion clinic prepped to think about trans-vaginal ultrasound as medical rape may well experience more negative outcomes than they would otherwise when they are informed by their health care provider that this procedure is necessary. It won’t matter that the trans-vaginal ultrasounds is called for not because the law mandates it but because the provider believes this ultrasound method is the correct medical choice.

We can see the second unintended consequence of this political approach in the experience in Virginia last year. After a very high profile “medical rape” fight over mandatory trans-vaginal ultrasound, the law was modified to remove the vaginal ultrasound requirement. An abdominal ultrasound is now acceptable.  All other aspects of the law were implemented. Despite a “political win” in Virginia, women receiving abortions are no better off. Instead, the real harms of the law—increased costs, loss of agency in health care decision-making—are obscured and ignored.

Rather than focus on the forced nature of the probe and the potential trauma to the woman of viewing her fetus, abortion rights supporters need to engage in a more honest conversation about what is wrong with the laws. These conversations are likely to be harder, more nuanced and not so easy to turn into sound bites. Mandatory ultrasound laws are wrong because they are provided in a way that drives up costs, because they make it harder to provide abortion care, and most importantly, because they do not improve health outcomes. They eliminate patient autonomy in how health care information is delivered and received. This is a truly egregious harm about which everyone, no matter their position on legal abortion, should be concerned. Trans-vaginal ultrasounds are not medical rape. They are often the preferred course of care. But in those circumstances where it is not medically necessary, ultrasounds should be provided using the clinician’s best judgment, just like any other health care interventions.

Unfortunately, this analysis will probably not lead the TV news tonight and that is part of what is wrong with the public discourse about abortion today.

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  • Lisa Maldonado

    Thanks for this piece Tracy. In our work, we have found that having an
    ultrasound on site can make the difference from being able to provide
    abortion care or not. As you state, ultrasounds help clinicians make
    accurate diagnoses and provide appropriate care for women.

    They
    are especially helpful for clinicians caring for women who are
    experiencing a miscarriage. It’s critical that we all understand how
    ultrasounds can be helpful in clinical care and ensure that clinicians have the
    freedom to use them as is clinically appropriate, not as mandated by
    law.

  • cjvg

    This account completely ignores the current reality that most women in the first trimester will now chose a medical abortion when at all available.
    These abortions do not require any type of ultrasound to be performed at all!
    Therefore mandating, or even justifying such as common practice is absolutely ridiculous and inane.

    Please do not encourage the practicing of medicine by ideological hardliners in our government.
    Most of whom are belligerent and disrespectful ideologues who only have a very minimal understanding of the human body and appropriate and needed medical care entails.
    Even worse most do not care what would be appropriate save medical care but will go out of their way to force their brand of morality or faith down everyone else’s throat, regardless of the opinion or believes of the person in question.

    • Rachael Vinyard

      I thought there was at least an initial ultrasound to determine gestational age.

      • cjvg

        No, during both my pregnancies no one even suggested an ultrasound until at least well into my third month.
        They asked when my last period was, when i tought i got pregnant and i already did my own blood test so that did not need to get done but would normally be part of the first visit.
        I myself are a clinical research associate and my husband is a doctor, you bet they crossed their t’s and dotted their i’s.
        Afterall we would have known if they supplied substandard care, not something that they would like to have get around in the medical community.

        • FacePalm4Jebus

          I honestly think you are making a big stink about nothing. I think you have taken this whole article way too personally and refuse to look outside your own circumstances or knowledge. Substandard care for not performing a u/s? Where was that accusation made? Nowhere. Just because you know of cases 9including your own) in which a u/s is not done doesn’t mean it is never used or necessary. It is a fact that medical practice does vary from provider to provider and even from region to region. Insurance companies have been tracking these things for years. I’ve had three children, my physician never once ordered a blood test to confirm my pregnancies for my first visit but I have know women whose Dr’s have. I peed on a stick, it said positive (which is just as good as a more expensive blood test) then I went to my 9 week appointment and boom…trans-vaginal u/s for gestational age. All three times! So does the fact that I didn’t have any of my pregnancies confirmed via blood test in my own personal experience mean that you are wrong that blood tests are the only way to go? Is my Doctor using resources wastefully? My point is that different providers do use different technologies to get the results they need depending on the client they are serving, the purpose for the test and the resources available to them (even in the face of standard accepted medical practices). That is not a level playing field. Perhaps if your goal had been to have an abortion rather than full term pregnancy (I am of course assuming that) they would have done a u/s to ensure the correct abortion was administered. I’m sure you fancy pants Dr husband might agree at least in part with what I’ve said. By the way my husband is a retail manager but that in no way makes me an expert on retail management by proxy.

          • cjvg

            I think you need to read again.
            I never said it was substandard care not to provide an ultra sound.
            I also never stated that only a blood test is acceptable.
            I don’t think you are actually understanding my argument.
            I do not believe a vaginal ultra sound should be a mandate to obtain a medical abortion.
            Furthermore i maintained that claiming that it had to be done for safety reasons so they could rule out a etopic pregnancy is a falacy, since a woman with a wanted pregnancy is not mandated to undergo an ultra sound the second she steps in her ob’s office although her risk would be higher since she aims to stay pregnant.
            Other then that you are making my argument for me.
            Yes providers differ, Yes it is not all done the same in every office or every region.
            So why mandate an ultra sound across a whole state?

            The FDA never even suggested or mandated an ultra sound as a pre requisite for the use of mifeprex or ru486 when they approved it for use in the US?
            Also, if these ultra sounds are that needed, why are there the proposed exemptions for rape victims?
            Do they not need the same standard of care, or is there suddenly a magical way to perform an abortion without one when you are a rape victim?!
            transvaginal ultrasounds are not a common prenatal procedure and are not used unless there is some additional medical problem that needs closer examination by a doctor.

            I’m not taking this article personal, however i do take the continued and absured assault on women very personal.

        • Ellen Mary

          Your pregnancies must have been long ago: a 6 week U/S is absolutely standard in conventional OB/GYN offices today . . .

          • cjvg

            My pregnancies were 12 and 13 years ago, not quite in the ice age thank you.
            I have worked in medical research for the past 18 years in many countries other then america (primarely northern europe)
            Pretty much all these countries left america in the dust regarding maternal and fetal death rates and health outcomes.
            Although my field was predominantly neurological and pharmaceutical, there were many times these did overlap with obstetrics.
            What i did notice that there was much less testing (although you are not always working with health pregnancies)
            America has hardely a place to argue that their way of doing things is that excellent as is proven by the outcome.
            Just because that is all you are familiar with that does not mean it is needed or best standard of care.

          • Ellen Mary

            !2 and 13 years ago is a VERY long time ago in the world of Obstetrics. A lot has changed even since my first pregnancy, 6 years ago . . .

          • Robin Marty

            I have a 2 year old and a 1 year old. I was not offered ultrasounds with either, an especially frustrating fact since my two year old was directly after a missed miscarriage for which I also was not given an ultrasound, so I did not learn I had miscarried until my 12 week appointment when they could not find a heartbeat with a doppler. I was then allowed to have an ultrasound the following day. unless you have an OBGYN with access to a machine, odds are you are not going to get an ultrasound prior to either a 14 week scan to check for anomolies (I’m forgetting the name of the scan but it checks nasal bone and neck fold) if you are past 35 or high risk, or your standard 20 week, unless you have gone long enough without a period to require a dating scan. Many of the pregnant women I know online lie about not knowing their last period in order to get a dating scan just to obtain an ultrasound early.

          • Ellen Mary

            I am sure, like most OB/GYN standards & practices, some of it depends on geography, but a 6 week dating scan is absolutely standard in the major medical practices in Charlotte, NC which is really smack in the middle as far as medical advancement/cutting edginess . . . You have to work pretty hard to opt out of it . . . Old school OBs might not offer it, but larger practices definitely do. A national survey would reveal this . . . Again, OBs are now definitely offering prenatal testing to all women, regardless of age . . . No lying is required . . . I am confused also, because while most OB practices utilize an U/S tech, what OB would not have access to an U/S machine? I mean I went to an independent *Homebirth* OB & he definitely had his own U/S machine . . . OBs don’t tend to be terrific with the doppler so they really need it!

      • FacePalm4Jebus

        Many Doctors DO in fact use them in exactly that way even if they are not necessary. Mine did and it confirmed what a simple pelvic exam had already told her. I never had to have my blood drawn to confirm my pregnancy either.

    • Tracy Weitz

      Yes it is true that about 25% of women will opt for a medication abortion. And while ultrasound is not required, it is almost always performed prior to medication abortion. An alternative protocol is used in the US that includes tracking hormones with blood draws. However, only a few providers do this and it is because they don’t have access to ultrasound not because they want to avoid the use of ultrasounds. In the case of medication abortion, done in the US up until 9 weeks of pregnancy, it is even more likely that a transvaginal ultrasound will be used.
      I am not encouraging hardliners. If you read my article you will see that I think these laws are bad. However, it is not the ultrasound that is the problem it is when and by whom they require the ultrasound to be offered that makes it harder to get an abortion.

      • cjvg

        Any unnecessary exam that has the bonus of humiliating and discomforting the women in question is a hard line.
        This is not a safety issue, any doctor worth their salt can easily establish is there is an indication to suspect an ectopic pregnancy and can then recommend a follow up with an ultra sound.
        As for gestational age, lets trust the woman for a change.

        A woman who has a planned pregnancy is rarely asked about the symptoms that indicate she is having an ectopic pregnancy and she also rarely is offered or ordered to have an ultra sound before she is at least 3 months pregnant.
        Obviously no one feels there are some serious lapses in safety protocol there since no one is protesting or promoting mandatory ultra sounds for these women upon first contact with a midwife or obstetrician.
        Which would lead me to make the logical conclusion, that this has nothing at all to do with safety.

        • Ellen Mary

          This is also completely false cjvg: it is *absolutely* standard to have a 6 week Ultrasound in any regular OB office, and the only women who skip them (they are the *standard* of care today) are Natural Health Types & Hippies who are concerned about U/S exposure. Actually most women also have a Nuchal Fold test that involves U/S again before 3 months also . . .

          • cjvg

            Nice, assert that your observations are absolutely the standard of care and then subsequently insinuate that i must be some”health or hippie” type (which of course must mean that i’am suspect as are my arguments)
            However when you are under 35 there is no standard that every woman must have a NT test or a ultra sound at or before 3 months, or even a blood test.
            (only after 35 a NT is routinely advised)
            Many OB’s accept a simple pee test as proof of pregnancy, and to check for glucose /albumin.

          • Ellen Mary

            Again, that has very much changed. Now prenatal testing has been extended to all women, regardless of age. 35 is yesteryear’s number. I am not insinuating YOU are a Hippie, I am stating that the only women who avoid the now standard 6 week dating Ultrasound are (like me) and it involves just not showing up at an OB/GYNs office. Call around, the standard of care now involves a dating U/S @ your first visit.

          • http://www.facebook.com/Feral.9.Hex Carla Clark

            Um, you do realize that you are bolstering cjvg’s arguments not refuting them? They were not medically indicated nor required, were they? If something is a standard of care, you would expect it to apply across the national board, no?

    • http://www.facebook.com/bromleybodam Nancy Bromley

      At the clinic I have been both a patient and volunteer at, an ultrasound is required to confirm gestational age regardless of if you opt for a medical or surgical abortion. It’s inaccurate to suggest medical abortions do not require an ultrasound.

      • http://www.facebook.com/profile.php?id=1098741283 Kristy Cole

        For me the point is that this is something that should be determined by the medical professional and the patient, not the politicians of the state you happen to live in. Although I am not disagreeing with you, I wanted to make that point.

      • cjvg

        The FDA, (never a bastion of enlightenment or against promoting the (over)use of unneeded medical procedures) has stated that an ultrasound is not needed for the safe use of medical abortion pills like RU486.

        Medical abortions have been available for about 20 years now, for most countries that was without a required ultrasound.
        When an ectopic pregnancy is suspected because the woman has some symptoms that point to such, then an ultrasound is done to rule out this complication.
        All this is easily detected during the initial intake and dr exam.

        The whole safety argument is BS, when you are going through a planned
        pregnancy no ultra sound is done until at least the third month (my first ultrasound with both was at 5 months of gestation)
        If it would have been an ectopic pregnancy I would have died or ended up in the hospital way before I got to that point.
        Also, not one single doctor ever asked me about the symptoms that indicate an ectopic pregnancy.
        The reason they require an ultra sound in America is the rabid anti choice crowd that forces the providers to take extensive steps to protect them selves.

        • Ellen Mary

          Planned Parenthood’s clinic policy is to do Ultrasounds before any abortion . . . Call them and ask.

          • cjvg

            I never contested that statement.
            What i contest is that they are always needed and that it is not a big deal that they are mandated.
            Unfortunately in this country planned parenthood despite all the good they do is somethimes required to administer test or procedures that are mainly done to keep the vultures of their back.

    • FacePalm4Jebus

      On the contrary, this “account” very definitely points out that that a u/s is not medically necessary
      and that it’s true intent is to drive up costs. I don’t think that point
      is lost simply because she did not name medication abortion
      specifically. Further more, it may not be necessary for a u/s to be
      performed prior to a medication abortion but there are many providers
      who do in fact perform these diagnostics simply to be sure that they
      have the gestational age correct as they medication my not be effective
      if the pregnancy is not as early as suspected.

      • cjvg

        I have extensively explained what my objections were.
        If you refuse to read, or just refuse to understand it i’m not going to write the same thing over and over.

  • nettwench14

    The plain fact is that ANY woman OR her physician can decide themselves whether or not such an ultrasound is necessary. MANDATING them is wrong, and especially wrong when based on pseudo-science or made-up statistics. These people LIE to justify passing these laws. It is that simple. They should not be allowed to do that. They should be countered by people with actual medical knowledge.Of course there is nothing wrong with a transvaginal ultrasound IF YOU WANT IT. Forcing it on people is completely unnecessary. And it IS an unwelcome intrusion and a violation not only OF YOUR BODY, but a violation OF YOUR RIGHT TO MEDICAL PRIVACY. HIPPA laws should negate these kinds of mandates anyway, but no one seems to be fighting these laws based on existing medical and legal practice.

    These people try to say they are giving women choices, when women ALREADY have these choices. It is patronizing and treats women as incapable of making their own decisions. We should fight this in every way necessary, including ANGER at an unwelcome intrusion into our bodies. I call that rape. It is no different from a penis being a welcome or unwelcome intrusion in my body. If I want it, it’s consensual. If I don’t it’s RAPE. What is so hard to understand about that?

    • http://www.facebook.com/tuibguy Mike Haubrich

      If I were a lawyer, and I am not, that would be the approach that I would use to invalidate those stupid laws. HIPAA, as a federal law, has supremacy over state law. I am not a lawyer, but I am sure that there are lawyers who read this site.

    • cjvg

      I absolutely agree!

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  • http://www.facebook.com/profile.php?id=800854312 Andria Schwortz

    When a state has laws mandating that a woman seeking an abortion view an ultrasound image or listen to a description of the fetus, does this mean that women who are blind and/or deaf are unable to obtain abortions since they are unable to view/listen to the mandatory items?

    • nettwench14

      I find that we sometimes end up splitting hairs, instead of just saying NO, because the grounds for requiring these things has no basis in anything other than religious objection to abortion. Let’s not get caught up in all of their rationalizations for these procedures, then we are just playing a losing game with these people. That’s my opinion.

      • http://www.facebook.com/ella.warnock.7 Ella Warnock

        You’re right. No woman has to justify or defend having an abortion.

  • http://www.facebook.com/people/Tahni-Danielle/100001811068244 Tahni Danielle

    If a survivor of rape is seeking to abort her rapist’s embryo, would you still shove a probe in her? You people need to stop incroaching on other people’s lives.

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  • Ellen Mary

    FALSE: cvjg: totally false on so many counts: Abortion by pill is not available for the entire first trimester. 9 weeks is standard but 7 is also sometimes used. Also, I had to have *two* TV ultrasounds for an Abortion by Pill @ the start of 6 weeks. That was to attempt to confirm uterine placement and to finally confirm uterine placement. Ectopic pregnancies are treated with a different drug (Methotrexate vis Mifepristone) & they need to figure out which type is present before proceeding in a Planned Parenthood. No one gave me an ‘option’ regarding this.

    • cjvg

      Just read, you are missing the whole point.

    • http://www.facebook.com/Feral.9.Hex Carla Clark

      Not medically indicated nor REQUIRED (to BECOME the standard of care) for normal healthy pregnancies, without any indication that it is for MEDICAL PURPOSES. THAT is cjvg’s point. So, please, some reading comprehension would be nice, ppl.

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  • John H

    Trans-vaginal ultrasounds are not medical rape. They are often the
    preferred course of care. But in those circumstances where it is not
    medically necessary, ultrasounds should be provided using the
    clinician’s best judgment, just like any other health care
    interventions.

    Aww, man, do we really have a writer for RHRC who doesn’t understand that the defining characteristic of rape is a lack of consent? Mandatory trans-vaginal ultrasounds involve the mandatory – read: consent is irrelevant – penetration of the vagina. That’s rape. The fact that trans-vaginal ultrasounds are standard care in many cases doesn’t make non-consensual probes not-rape any more than the fact that most PIV sex is consensual makes forced penetration not-rape.

    We’re focusing on the state-mandated rape aspect because that’s the biggest problem. Sure, the laws don’t do what they’re nominally intended to do, but then those proposing them already know that. The rationalizations are just that; the actual intent of the laws is to shame and humiliate women seeking to end their pregnancies. Laws that don’t accomplish what they intend aren’t great, but they’re nowhere near as bad as laws that mandate assault. Lots of good content in the article, but it really should be framed as a, “The whole rape part is bad, and even if it wasn’t, these laws still don’t do what they claim,” argument, not in a way that elides the fact that non-consensual vaginal penetration is f**king rape.

  • Paula Trietsch Chaney

    Have you ever actually had a transvaginal probe ultrasound? I have. Twice. For 2 days afterward I had severe cramps, cramps so horrific I vomited frequently from the pain. My abdomen felt like my organs had been scrambled. My vagina was incredibly sore, and it was weeks before I was entirely myself. It is entirely appropriate to call it medical rape when it is forcefully and unnecessarily done. .

  • lou4

    The new definition of rape is “The penetration, no matter how slight…with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.” By that definition, use of the trans-vaginal ultrasound, without the consent of the woman, is rape.

    The Constitution gives no authority to legislators to force medical procedures on women. Allowing these kinds of laws to stand sets the precedent that other medical procedures could be forced on women, children and even men when there is a different political climate, including forcing them to pay for it.

    These laws interfere with the doctor/patient relationship and any human being’s right to say “No.”

  • http://twitter.com/Tonks07 Mandy

    Also, imagine how these laws requiring women to see/listen to the doctor talk about how far developed the fetus is effect women who have WANTED pregnancies but are getting abortion because they have to. Because the fetus is non viable in some way. I wish I could find it again but I read a woman’s story about just that and it really touched my heartstrings. You are forcing that woman/couple to hear about a child they wanted but can not have. The law is practically mandating you torture that woman/couple by forcing them to hear and learn about a child they wanted but now cannot have for medical reasons. & that’s disgusting.