Abortion Law Development: A Brief Overview

Congressional research reportJan 2, 2001

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Order Code 95-724 A

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Abortion Law Development:

A Brief Overview

Updated January 2, 2001

Karen J. Lewis and Jon O. Shimabukuro

Legislative Attorneys

American Law Division

Congressional Research Service ˜ The Library of Congress

Abortion Law Development:

A Brief Overview

Summary

In Roe v. Wade, 410 U.S. 113 (1973), the U.S. Supreme Court determined that

the Constitution protects a woman’s decision whether or not to terminate her

pregnancy. In a companion case, Doe v. Bolton, 410 U.S. 179 (1973), the Court held

further that a state may not unduly burden a woman’s fundamental right to abortion

by prohibiting or substantially limiting access to the means of effectuating her

decision. Rather than settle the issue, the Court’s decisions kindled heated debate

and precipitated a variety of governmental actions at the national, state and local

levels designed either to nullify the rulings or hinder their effectuation. These

governmental regulations have, in turn, spawned further litigation in which resulting

judicial refinements in the law have been no more successful in dampening the

controversy.

The law with respect to abortion in mid-19th century America followed the

common law of England in all but a few states. By the time of the Civil War, a

number of states had begun to revise their statutes in order to prohibit abortion at all

stages of gestation, with various exceptions for therapeutic abortions.

1967 saw the first victory of an abortion reform movement with the passage of

liberalizing legislation in Colorado. The legislation was based on the Model Penal

Code. Between 1967 and 1973, approximately one-third of the states had adopted,

either in whole or in part, the Model Penal Code’s provisions allowing abortion in

instances other than where only the mother’s life was in danger.

Between 1968 and 1972, abortion statutes of many states were challenged on the

grounds of vagueness, violation of the fundamental right of privacy, and denial of

equal protection. In 1973, the Court ruled in Roe and Doe that Texas and Georgia

statutes regulating abortion interfered to an unconstitutional extent with a woman’s

right to decide whether to terminate her pregnancy. The decisions rested upon the

conclusion that the Fourteenth Amendment right of personal privacy encompassed

a woman’s decision whether to carry a pregnancy to term.

The Supreme Court’s decisions in Roe and Doe did not address a number of

important abortion-related issues which have been raised subsequently by state

actions seeking to restrict the scope of the Court’s rulings. These include the issues

of informed consent, spousal consent, parental consent, and reporting requirements.

In addition, Roe and Doe never resolved the question of what, if any, type of abortion

procedures may be required or prohibited by statute. In 1989, the Court indicated in

Webster v. Reproductive Health Services, 492 U.S. 490, that, while it was not

overruling Roe and Doe, it was willing to apply a less stringent standard of review

to state restrictions respecting a woman’s right to an abortion. Then, in 1992, in

Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833 (1992),

the Court rejected specifically Roe’s strict scrutiny standard and adopted the undue

burden analysis. Finally, in 2000, the Court in Stenberg v. Carhart, 530 U.S. 914,

120 S.Ct. 2597 (2000), determined that a Nebraska statute prohibiting the

performance of “partial-birth” abortions is unconstitutional.

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

I. Development and Status of the Law Prior to 1973 . . . . . . . . . . . . . . . . 1

II. The Supreme Court’s 1973 Abortion Rulings . . . . . . . . . . . . . . . . . . . . 2

III. Public Funding of Abortions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

IV. Supreme Court Decisions Subsequent to Roe and Doe Involving

the Substantive Right to Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Informed Consent/Waiting Periods . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Spousal/Parental Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Parental Notification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

V. Setting the Stage for Casey: Webster v. Reproductive Health

Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

VI. A Shift in Direction: Planned Parenthood of Southeastern

Pennsylvania v. Casey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

VII. Applying Casey: Stenberg v. Carhart . . . . . . . . . . . . . . . . . . . . . . . . . 15

Abortion Law Development:

A Brief Overview

Introduction

In Roe v. Wade, the U.S. Supreme Court determined that the Constitution

protects a woman’s decision whether or not to terminate her pregnancy.1 In a

companion case, Doe v. Bolton, the Court held further that a state may not unduly

burden a woman’s fundamental right to abortion by prohibiting or substantially

limiting access to the means of effectuating her decision.2 Rather than settle the

issue, the Court’s decisions kindled heated debate and precipitated a variety of

governmental actions at the national, state and local levels designed either to nullify

the rulings or hinder their effectuation. These governmental regulations have, in turn,

spawned further litigation in which resulting judicial refinements in the law have

been no more successful in dampening the controversy.

This report offers an overview of the development of abortion law from 1973

to the present. Beginning with a brief discussion of the historical background, the

report analyzes the leading Supreme Court decisions over the past twenty-eight years,

emphasizing particularly the landmark decisions in Roe and Doe, the Court’s shift

in direction in Webster v. Reproductive Health Services and Planned Parenthood of

Southeastern Pennsylvania v. Casey, and the Court’s most recent decision on

abortion, Stenberg v. Carhart.3 The Court’s decisions on the constitutionality of

restricting public funding for abortion are also discussed.

I.

Development and Status of the Law Prior to 1973

The law with respect to abortion in mid-19th century America followed existing

common law of England in all but a few states.4 Thus, no indictment would occur

for aborting a fetus of a consenting female prior to “quickening.” But, by the time

of the Civil War, an influential anti-abortion movement began to affect legislation

by inducing states to add to or revise their statutes in order to prohibit abortion at all

1

410 U.S. 113 (1973).

2

410 U.S. 179 (1973).

3

Webster v. Reproductive Health Services, 492 U.S. 490 (1989); Planned Parenthood of

Southwestern Pennsylvania v. Casey, 505 U.S. 833 (1992); Stenberg v. Carhart, 530 U.S.

914 (2000).

4

For additional discussion of the historical development of the regulation of abortion, see

Roe v. Wade, 410 U.S. 113, 130-41. See also, Eugene Quay, “Justifiable Abortion–Medical

and Legal Foundations,” 49 Geo. L.J. 173 (Winter 1960) and 49 Geo L.J. 395 (Spring 1961);

James C. Mohr, Abortion in America (1978).

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stages of gestation. By 1910, every state had anti-abortion laws, except Kentucky

whose courts judicially declared abortions to be illegal. In 1967, forty-nine states and

the District of Columbia classified the crime of abortion as a felony. The concept of

“quickening” was no longer used to determine criminal liability but was retained in

some states to set punishment. Nontherapeutic abortions were essentially unlawful.

The states varied in their exceptions for therapeutic abortions. Forty-two states

permitted abortions only if necessary to save the life of the mother. Other states

allowed abortion to save a woman from “serious permanent bodily injury” or her

“life and health.” Three states allowed abortions that were not “unlawfully

performed” or that were not “without lawful justification”, leaving interpretation of

those standards to the courts.

This, however, represented the high water mark in restrictive abortion laws in

the United States, for 1967 saw the first victory of an abortion reform movement with

the passage of liberalizing legislation in Colorado. The movement had started in the

early 1950s and centered its efforts on a proposed criminal abortion statute developed

by the American Law Institute as part of its Model Penal Code that would allow

abortions when childbirth posed grave danger to the physical or mental health of a

woman, when there was high likelihood of fetal abnormality, or when pregnancy

resulted from rape or incest.

Between 1967 and the Supreme Court’s 1973 decisions in Roe and Doe,

approximately one-third of the states had adopted, either in whole or in part, the

Model Penal Code’s provisions allowing abortions in instances other than where only

the mother’s life was in danger. Also, by the end of 1970, four states (Alaska,

Hawaii, New York, and Washington) had repealed criminal penalties for abortions

performed in early pregnancy by a licensed physician, subject to stated procedural

and health requirements.

The first U.S. Supreme Court decision dealing with abortion was rendered in

1971. In United States v. Vuitch, the Court denied a vagueness challenge to the

District of Columbia abortion statute.5 The net effect of the Vuitch decision was to

expand the availability of abortions under the D.C. law’s provision allowing

abortions where “necessary for the preservation of the mother’s...health.”

II. The Supreme Court’s 1973 Abortion Rulings

Between 1968 and 1972, the constitutionality of restrictive abortion statutes of

many states was challenged on the grounds of vagueness, violation of the

fundamental right of privacy, and denial of equal protection. These challenges met

with mixed success in the lower courts. However, in 1973, the Supreme Court issued

its rulings in Roe v. Wade and Doe v. Bolton. In those cases the Court found that

Texas and Georgia statutes regulating abortion interfered to an unconstitutional

extent with a woman’s right to decide whether to terminate her pregnancy. The

Texas statute forbade all abortions not necessary “for the purpose of saving the life

of the mother.” The Georgia enactment permitted abortions when continued

pregnancy seriously threatened the woman’s life or health, when the fetus was very

5

402 U.S. 62 (1971).

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likely to have severe birth defects, or when the pregnancy resulted from rape. The

Georgia statute required, however, that abortions be performed only at accredited

hospitals and only after approval by a hospital committee and two consulting

physicians.

The Court’s decisions were delivered by Justice Blackmun for himself and six

other Justices. Justices White and Rehnquist dissented. The Court ruled that states

may not categorically proscribe abortions by making their performance a crime, and

that states may not make abortions unnecessarily difficult to obtain by prescribing

elaborate procedural guidelines. The constitutional basis for the decisions rested

upon the conclusion that the Fourteenth Amendment right of personal privacy

embraced a woman’s decision whether to carry a pregnancy to term. The Court noted

that its prior decisions had “found at least the roots of...[a] guarantee of personal

privacy” in various amendments to the Constitution or their penumbras (i.e.,

protected offshoots) and characterized the right to privacy as grounded in “the

Fourteenth Amendment’s concept of personal liberty and restrictions upon State

action.”6 Regarding the scope of that right, the Court stated that it included “only

personal rights that can be deemed ‘fundamental’ or ‘implicit in the concept of

ordered liberty’” and “bears some extension to activities related to marriage,

procreation, contraception, family relationship, and child rearing and education.”7

Such a right, the Court concluded, “is broad enough to encompass a woman’s

decision whether or not to terminate her pregnancy.”8

With respect to protection of the right against state interference, the Court held

that since the right of personal privacy is a fundamental right, only a “compelling

state interest” could justify its limitation by a state. Thus while it recognized the

legitimacy of the state interest in protecting maternal health and the preservation of

the fetus’ potential life, and the existence of a rational connection between these two

interests and the state’s anti-abortion law, the Court held these interests insufficient

to justify an absolute ban on abortions.9 Instead, the Court emphasized the durational

nature of pregnancy and held the state’s interests to be sufficiently compelling to

permit curtailment or prohibition of abortion only during specified stages of

pregnancy. The High Court concluded that until the end of the first trimester, an

abortion is no more dangerous to maternal health than childbirth itself, and found

that: “[W]ith respect to the State’s important and legitimate interest in the health of

the mother, the ‘compelling’ point, in light of present medical knowledge, is at

approximately the end of the first trimester.”10 Only after the first trimester does the

state’s interest in protecting maternal health provide a sufficient basis to justify state

regulation of abortion, and then only to protect this interest.11

6

Roe, 410 U.S. at 152.

7

Roe, 410 U.S. at 152-3.

8

Roe, 410 U.S. at 153.

9

Roe, 410 U.S. at 148-50.

10

Roe, 410 U.S. at 163.

11

Roe, 410 U.S. at 163-4.

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The “compelling” point with respect to the state’s interest in the potential life

of the fetus “is at viability.” Following viability, the state’s interest permits it to

regulate and even proscribe an abortion except when necessary, in appropriate

medical judgment, for the preservation of the life or health of the mother.12 The

Court defined viability as the point at which the fetus is “potentially able to live

outside the mother’s womb, albeit with artificial aid.”13 It summarized its holding

as follows:

(a) For the stage prior to approximately the end of the first trimester [of

pregnancy], the abortion decision and its effectuation must be left to the medical

judgment of the pregnant woman’s attending physician.

(b) For the stage subsequent to approximately the end of the first trimester, the

State, in promoting its interest in the health of the mother, may, if it chooses,

regulate the abortion procedure in ways that are reasonably related to maternal

health.

(c) For the stage subsequent to viability, the State, in promoting its interest in the

potentiality of human life may, if it chooses, regulate, and even proscribe,

abortion except where it is necessary, in appropriate medical judgment, for the

preservation of the life or health of the mother.14

In Doe, the Court reiterated its holding in Roe that the basic decision of when

an abortion is proper rests with the pregnant mother and her physician, but extended

Roe by warning that just as states may not prevent abortion by making their

performance a crime, states may not make abortions unreasonably difficult to obtain

by prescribing elaborate procedural barriers. In Doe, the Court struck down state

requirements that abortions be performed in licensed hospitals; that abortions be

approved beforehand by a hospital committee; and that two physicians concur in the

abortion decision.15 The Court appeared to note, however, that this would not apply

to a statute that protected the religious or moral beliefs of denominational hospitals

and their employees.16

The Court in Roe also dealt with the question whether a fetus is a person and

thereby protected under the Fourteenth Amendment and other provisions of the

Constitution. The Court indicated that the Constitution never specifically defines,

“person,” but added that in nearly all the sections where the word person appears,

“the use of the word is such that it has application only post-natally. None indicates

with any assurance, that it has any possible pre-natal application.”17 The Court

emphasized that, given the fact that in the major part of the 19th century prevailing

12

Roe, 410 U.S. at 163-4.

13

Roe, 410 U.S. at 160.

14

Roe, 410 U.S. at 164-5.

15

Doe, 410 U.S. at 196-9.

16

Doe, 410 U.S. at 197-8.

17

Roe, 410 U.S. at 157.

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legal abortion practices were far freer than today, the Court was persuaded “that the

word ‘person,’ as used in the Fourteenth Amendment, does not include the unborn.”18

The Court did not, however, resolve the question of when life actually begins.

While noting the divergence of thinking on this issue, it instead articulated the legal

concept of “viability,” defined as the point at which the fetus is potentially able to

live outside the womb, although the fetus may require artificial aid.19 Many other

questions were also not addressed in Roe and Doe, but instead formed the grist for

a burgeoning book of post-Roe litigation.

III. Public Funding of Abortions

Two categories of public funding cases have been heard and decided by the

Supreme Court: those involving (1) funding restrictions for nontherapeutic (elective)

abortions; and (2) funding limitations for therapeutic (medically necessary) abortions.

(1) The 1977 Trilogy -- Restrictions on Public Funding of Nontherapeutic or

Elective Abortions

The Supreme Court, in three related decisions, ruled on the question whether the

Medicaid statute or the Constitution requires public funding of nontherapeutic

(elective) abortions for indigent women or access to public facilities for the

performance of such abortions.20 The Court held that the states have neither a

statutory nor a constitutional obligation in this regard.

In Beal v. Doe, the Court held that nothing in the language or legislative history

of Title XIX of the Social Security Act (Medicaid) requires a participating state to

fund every medical procedure falling within the delineated categories of medical

care. The Court ruled that it was not inconsistent with the Act’s goals to refuse to

fund unnecessary medical services. However, the Court did indicate that Title XIX

left a state free to include coverage for nontherapeutic abortions should it choose to

do so. Similarly, in Maher v. Roe, the Court held that the Equal Protection Clause

of the U.S. Constitution does not require a state participating in the Medicaid

program to pay expenses incident to nontherapeutic abortions simply because the

state has made a policy choice to pay expenses incident to childbirth. More

particularly, Connecticut’s policy of favoring childbirth over abortion was held not

to impinge upon the fundamental right of privacy recognized in Roe, which protects

a woman from undue interference in her decision to terminate a pregnancy. Finally,

in Poelker v. Doe, the Court upheld a municipal regulation that denied indigent

pregnant women nontherapeutic abortions at public hospitals. It also held that

staffing those hospitals with personnel opposed to the performance of abortions did

not violate the Equal Protection Clause of the Constitution. Poelker, however, did

18

Roe, 410 U.S. at 158.

19

Roe, 410 U.S. at 160.

20

See Beal v. Doe, 432 U.S. 438 (1977); Maher v. Roe, 432 U.S. 464 (1977); Poelker v.

Doe, 432 U.S. 519 (1977) (per curiam).

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not deal with the question of private hospitals and their authority to prohibit abortion

services.

(2) Public Funding of Therapeutic or Medically Necessary Abortions

The 1977 Supreme Court decisions left open the question whether Federal law,

such as the Hyde Amendment, or similar state laws, could validly prohibit

governmental funding of therapeutic abortions.

The Court ruled 5-4 that the Hyde Amendment’s abortion funding restrictions

were constitutional. The majority found that the Hyde Amendment neither violated

the Due Process or Equal Protection guarantees of the Fifth Amendment nor the

Establishment [of religion] Clause of the First Amendment. The Court also upheld

the right of a state participating in the Medicaid program to fund only those medically

necessary abortions for which it received Federal reimbursement.21 In companion

cases raising similar issues, the Court held that a State of Illinois statutory funding

restriction comparable to the Federal Hyde Amendment also did not contravene the

constitutional restrictions of the Equal Protection Clause of the Fourteenth

Amendment.22 The Court’s rulings mean there is no statutory or constitutional

obligation of the states or the Federal Government to fund all medically necessary

abortions.

IV. Supreme Court Decisions Subsequent to Roe and Doe

Involving the Substantive Right to Abortion

Informed Consent/Waiting Periods. In Planned Parenthood v. Danforth,

the Court held that informed consent statutes, which require a doctor to obtain the

written consent of a woman after informing her of the dangers of abortion and

possible alternatives, are constitutional if the requirements are related to maternal

health and are not overbearing.23 The fact that the informed consent laws must define

their requirements very narrowly in order to be constitutional was later confirmed the

Supreme Court in 1979.24 The requirements of an informed consent statute must also

be narrowly drawn so as not to unduly interfere with the physician-patient

relationship, although the type of information required to be given to a woman of

necessity may vary according to the trimester of her pregnancy.

In City of Akron v. Akron Center for Reproductive Health, Inc., along with

various other provisions, the Court struck down the informed written consent section

of the ordinance.25 This provision required that the attending doctor inform the

woman “of the status of her pregnancy, the development of her fetus, the date of

21

See Harris v. McRae, 448 U.S. 297 (1980)

22

See Williams v. Zbaraz; Miller v. Zbaraz; U.S. v. Zbaraz, 448 U.S. 358 (1980).

23

428 U.S. 52 (1976).

24

See Freiman v. Ashcroft, 584 F.2d 247, 251 (8th Cir. 1978), aff’d mem., 440 U.S. 941

(1979).

25

462 U.S. 416 (1983).

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possible viability, the physical and emotional complications that may result from an

abortion, and the availability of agencies to provide her with assistance and

information with respect to birth control, adoption, and childbirth.”26 The attending

physician was also required to tell the patient of the risks involved and any other

information which in the physician’s medical judgment would be critical to her

decision of whether to terminate the pregnancy. The Court found this informed

consent requirement to be constitutionally unacceptable because it essentially gave

the government unreviewable authority over what information was to be given a

woman before she decided whether to have an abortion. It was also objectionable

because it intruded upon the discretion of the pregnant woman’s doctor.27

The Supreme Court also invalidated the 24-hour waiting period, holding that

the City of Akron had not shown that any legitimate state interest was being served

“by an arbitrary and inflexible waiting period.”

Spousal/Parental Consent. In addition to informed consent, the Court in

Danforth, found that spousal consent statutes, which require a written statement by

the father of the fetus affirming his consent to the abortion, are unconstitutional if the

statutes allow the husband to unilaterally prohibit the abortion in the first trimester.

It should be noted that on the same day that the Supreme Court decided Danforth, it

also summarily affirmed the lower court decision in Coe v. Gerstein, which held

unconstitutional a spousal consent law regardless of the stage of the woman’s

pregnancy.28

With respect to parental consent statutes, the Supreme Court held in Danforth

that statutes which allow a parent or guardian to absolutely prohibit an abortion to be

performed on a minor child were unconstitutional. Subsequently, in Bellotti v. Baird,

the Court ruled that while a state may require a minor to obtain parental consent, it

must also provide an alternative procedure to procure authorization if parental

consent is denied or the minor does not want to seek it.29 Bellotti thus entitles a

minor to some proceeding which allows her to prove her ability to make an informed

decision independent of her parents or, even if she is incapable of making the

decision, at least showing that the abortion would be in her best interests.

In City of Akron, the Court invalidated the provision in the Akron ordinance

which prohibited a doctor from performing an abortion on an unemancipated minor

unless the doctor obtained “the informed written consent of one of her parents or her

legal guardian” or unless the minor herself obtained “an order from a court having

jurisdiction over her that her abortion be performed or induced.”30 The Court relied

on its earlier rulings in Danforth and Bellotti to conclude that the City of Akron could

“not make a blanket determination that all minors under the age of 15 are too

26

City of Akron, 462 U.S. at 442.

27

City of Akron, 462 U.S. at 445.

28

376 F.Supp. 695 (S.D. Fla. 1974), aff’d, 428 U.S. 901 (1976).

29

443 U.S. 622 (1979).

30

City of Akron, 462 U.S. at 439.

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immature to make this decision or that an abortion never may be in the minor’s best

interests without parental approval.”31 Moreover, the Akron ordinance’s provision

concerning parental approval did not create expressly the alternative judicial

procedure required by Bellotti. Thus, the ordinance’s consent provision had to fall

because it foreclosed any possibility for “case-by-case evaluations of the maturity of

pregnant minors.”32

In Planned Parenthood Association of Kansas City, Missouri Inc. v. Ashcroft,

the Supreme Court upheld Missouri’s parental consent requirement.33 It

distinguished the provision involved here from that challenged in City of Akron. The

Missouri requirement, unlike the Akron one, did provide an alternative procedure by

which a pregnant immature minor could show in court that she was sufficiently

mature to make the abortion decision herself or that, despite her immaturity, an

abortion would in her best interests.

Parental Notification. In 1981, the Court upheld a Utah state law making it

a crime for doctors to perform an abortion on an unemancipated, dependent minor

without notifying her parents. In H. L. v. Matheson, a 6-3 decision, the Court

examined the narrow question of the facial constitutionality of a statute requiring a

physician to give notice to parents, “if possible,” prior to performing an abortion on

their minor daughter: (a) when the girl is living with and dependent upon her

parents; (b) when she is not emancipated by marriage or otherwise; and (c) when she

has made no claim or showing as to her maturity or as to her relationship with her

parents.34 The Supreme Court cited the interest in preserving family integrity and

protecting adolescents in allowing states to require that parents be informed that their

daughter is seeking an abortion, and emphasized that the statute in question did not

give a veto power over the minor’s abortion decision. The Court rejected the minor

woman’s contention that abortion was being singled out for special treatment in

contrast to other surgical procedures, like childbirth, which do not require parental

notice.

In 1987, an equally divided Supreme Court, without opinion, let stand a 7th

Circuit Court of Appeals decision invalidating an Illinois law that required teenagers

to notify their parents prior to obtaining an abortion.35 The tie vote meant that the

ruling set no nationwide precedent. There are other states with parental notification

laws similar to the one in Illinois.

During its October 1989 Term, the Court decided two cases involving

challenges to the constitutionality of state parental notification laws.36 In the

31

City of Akron, 462 U.S. at 440.

32

City of Akron, 462 U.S. at 441 (quoting Bellotti, 443 U.S. at 642 n.23.).

33

462 U.S. 476 (1983).

34

450 U.S. 398 (1981).

35

See Hartigan v. Zbaraz, 484 U.S. 171 (1987).

36

See Hodgson v. Minnesota, 497 U.S. 417 (1990); Ohio v. Akron Center for Reproductive

(continued...)

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Minnesota case, the Court held 5 to 4 that a state requirement for notice to be given

to both parents prior to a minor’s having an abortion was unconstitutional unless the

state legislature provided for an alternative hearing in court, i.e., a judicial bypass

procedure.

The Court ruled 6 to 3 in the Ohio case that Ohio’s law requiring notice to one

parent with a judicial bypass option was constitutional. Justice Kennedy wrote the

opinion for the majority. Both the Minnesota and Ohio decisions have been viewed

as consistent with the Court’s prior rulings concerning parental consent requirements

for minors.

Miscellaneous. (1) Reporting Requirements

The Court in Danforth ruled that statutes requiring doctors and health facilities

to provide information to states regarding each abortion performed are constitutional.

The Court specified, however, that these reporting requirements must relate to

maternal health, remain confidential, and may not be overbearing.37

In Ashcroft, the Court upheld the pathology report requirement. This provision

was “related to generally accepted medical standards” and “further[s] important

health-related State concerns.”38 The Court further found that the cost of the tissue

examination “does not significantly burden a pregnant woman’s abortion decision.”39

(2) Advertisement of Abortion Services

The Supreme Court held in Bigelow v. Virginia, that a state may not proscribe

advertising regarding the availability of an abortion or abortion-related services in

another state.40 The Court found that the statute in question was unconstitutional

because the State of Virginia, where the advertisement appeared, had only a minimal

interest in the health and medical practices of New York, the state in which the legal

abortion services were located.

(3) Abortions by Nonphysicians

In Connecticut v. Menillo, the Supreme Court ruled that state statutes similar to

the Texas law challenged in Roe were constitutional to the extent that the statutes

forbid nonphysicians from performing abortions.41 The Roe decision made it clear

that a state could not interfere with a woman’s decision, made in consultation with

and upon the advice of her doctor, to have an abortion in the first trimester of her

36

(...continued)

Health, 497 U.S. 502 (1990).

37

Danforth, 428 U.S. at 80-1.

38

Ashcroft, 462 U.S. at 487.

39

Ashcroft, 462 U.S. at 490.

40

421 U.S. 809 (1975).

41

423 U.S. 9 (1975).

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pregnancy. The Menillo Court found that pre-Roe restrictive abortion laws were still

enforceable against nonphysicians.42

(4) Locus of Abortions

In City of Akron, the Court invalidated the challenged Akron ordinance

provision relating to where abortions can be performed. The requirement stated that

any second trimester abortion had to be performed in a full-service hospital. The

accreditation of these facilities required compliance with comprehensive standards

governing an extensive variety of health and surgical services. The result was that

abortions under this section of the Akron ordinance could not be performed in

outpatient facilities that were not part of an acute-care, full-service hospital. The

Court found this restriction unconstitutional, noting that the possibility of having to

travel to find facilities could result in both financial expense and added risk to a

woman’s health.43 The Court also cited changed medical circumstances, and the

availability of safer procedures for performing second trimester abortions since Roe,

for its conclusion that the Akron hospitalization requirement imposed an

unreasonable burden on a woman’s right to an abortion.

In Ashcroft, the Court invalidated Missouri’s second trimester hospitalization

requirement by the same 6-3 vote as in City of Akron. It said its decision and

rationale in City of Akron were controlling.

In Simopoulos v. Virginia, the Supreme Court ruled that Virginia’s mandatory

hospitalization requirement for second trimester abortions was constitutional.44 The

Court distinguished the requirement in question from those it invalidated in City of

Akron and Ashcroft which mandated that all second trimester abortions be performed

in acute-care facilities. In Simopoulos, the Court said that, in contrast, the Virginia

law did not require that second trimester abortions be performed exclusively in fullservice hospitals. The determination upholding the Virginia provision actually turned

on the definition of “hospital.” The Court wrote: “Under Virginia’s hospitalization

requirement, outpatient surgical hospitals may qualify for licensing as `hospitals’ in

which second-trimester abortions lawfully may be performed.”45

(5) Viability, Fetal Testing, and Disposal of Fetal Remains

The Supreme Court’s articulation of the concept of viability has required further

elaboration, particularly with regard to the critical question of who defines at what

point a fetus has reached viability. In Roe, the Court defined viability as the point at

which the fetus is “potentially able to live outside the mother’s womb, albeit with

artificial aid.”46 Such potentiality, however, must be for “meaningful life” and this

42

Menillo, 423 U.S. at 9-11.

43

City of Akron, 462 U.S. at 435.

44

462 U.S. 506 (1983).

45

Simopoulos, 462 U.S. at 516.

46

Roe, 410 U.S. at 160.

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cannot encompass simply momentary survival.47 The Court also noted that while

viability is usually placed at about 28 weeks, it can occur earlier and essentially left

the point flexible for anticipated advances in medical skill. Finally, Roe stressed the

central role of the pregnant woman’s doctor, emphasizing that “the abortion decision

in all its aspects is inherently, and primarily, a medical decision.”48

Similar themes were stressed in Danforth, in which a Missouri law, which

defined viability as “that stage of fetal development when the life of the unborn child

may be continued indefinitely outside the womb by natural or artificial life support

systems”, was attacked as an attempt to advance the point of viability to an earlier

stage of gestation. The Court disagreed, finding the statutory definition consistent

with Roe. It reemphasized that viability is “a matter of medical judgment, skill, and

technical ability” and that Roe meant to preserve the flexibility of the term.49

Moreover, the Danforth Court held that “it is not the proper function of the

legislature or the courts to place viability, which is essentially a medical concept, at

a specific point in the gestation period. The time when viability is achieved may vary

with each pregnancy, and the determination of whether a particular fetus is viable is,

and must be, a matter for the judgment of the attending physician.”50 The physician’s

central role in determining viability, and the lack of such definitional authority in the

legislatures and courts, was reaffirmed by the Court in Colautti v. Franklin.51

In Danforth, the Court ruled that fetal protection statutes were generally

overbroad and unconstitutional if they pertained to pre-viable fetuses. Such statutes

require a doctor performing an abortion to use available means and medical skills to

save the life of the fetus. In Colautti, the Supreme Court held subsequently that such

fetal protection statutes could only apply to viable fetuses and that the statute must

be precise in setting forth the standard for determining viability. In addition, the

Court in Colautti stressed that in order to meet the constitutional test of sufficient

certainty, fetal protection laws had to define whether a doctor’s paramount duty was

to the patient or whether the physician had to balance the possible danger to the

patient against the increased odds of fetal survival.52

In Ashcroft, the Court found that the second-physician requirement during the

third trimester was permissible under the Constitution because it “reasonably furthers

the State’s compelling interest in protecting the lives of viable fetuses . . .”53

In City of Akron, the Court ruled that the portion of the Akron ordinance

requiring that physicians performing abortions see to it that the remains of the unborn

child be disposed of “in a humane and sanitary” way was void for vagueness. The

47

Roe, 410 U.S. at 163.

48

Roe, 410 U.S. at 160.

49

Danforth, 428 U.S. at 64.

50

Id.

51

439 U.S. 379 (1979).

52

Colautti, 439 U.S. at 379, 397-401.

53

Ashcroft, 462 U.S. at 486.

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level of uncertainty present was unacceptable in a situation such as this where there

was the prospect of criminal liability being imposed.54

V. Setting the Stage for Casey: Webster v. Reproductive

Health Services

The 1983 Supreme Court decisions in City of Akron, Ashcroft, and Simopoulos

settled questions relating to hospital requirements for second trimester abortions,

informed consent requirements, waiting periods, parental notification and consent,

and disposal of fetal remains. The Supreme Court reaffirmed its decision in Roe and

its intention to continue to follow the trimester framework balancing a woman’s

constitutional right to decide whether to terminate a pregnancy with the State’s

interest in protecting potential life. The State’s interest in protecting potential life

becomes “compelling” at the point of viability, i.e., when the fetus can exist outside

of a woman’s womb either on its own or through artificial means. The definition of

viability is the one used by the Court in its Roe decision in 1973. Again, in 1986, the

Court reaffirmed Roe in Thornburgh v. American College of Obstetricians and

Gynecologists.55

In 1989, the Supreme Court upheld the constitutionality of the State of

Missouri’s abortion statute in Webster v. Reproductive Health Services.56 In this 5-4

decision, while the majority did not overrule Roe, it indicated that it was willing to

apply a less stringent standard of review to state restrictions on abortion. Webster

made it clear that state legislatures have considerable discretion to pass restrictive

legislation in the future, with the likelihood that such laws would probably pass

constitutional muster.

The main provisions in the 1986 Missouri law upheld by the Court included: (1)

barring public employees from performing or assisting in abortions not necessary to

save the life of the mother; (2) barring the use of public buildings for performing

abortions, despite the fact that there were no public monies involved (e.g., a building

situated on public land); and (3) requiring physicians believing a woman desiring an

abortion to be at least 20 weeks pregnant to perform tests to determine whether the

fetus is viable. The Court’s majority chose not to rule on the Missouri law’s

Preamble language which described life as beginning at conception with

constitutional protections attaching at that point. Chief Justice Rehnquist, writing for

the Court, said that the Preamble by its terms did not regulate abortion, and that it

was an expression of a value judgment favoring childbirth over abortion. He noted

that the Court in past cases has emphasized that Roe implies no limitation on a

State’s authority to make such a value judgment. The Webster ruling was narrow in

that it did not affect private doctors’ offices or clinics, where most abortions are

performed. Its significance derives more from the rationales articulated by the five

justices regarding how abortion restrictions would be reviewed in the future. Webster

set the stage for the Court’s 1992 decision in Casey.

54

City of Akron, 462 U.S. at 451.

55

476 U.S. 747 (1986).

56

492 U.S. 490 (1989).

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The majority opinion in Webster became splintered when the justices reviewed

the Missouri provision respecting a doctor’s testing for viability at 20 weeks of

pregnancy. While the five justices (Rehnquist, White, Kennedy, Scalia, and

O’Connor) agreed that the provision was constitutional, they had different reasons

for so holding. Chief Justice Rehnquist, joined by Justices White and Kennedy,

agreed with the district court and court of appeals that the required tests added

increased costs to obtaining a second trimester abortion. In Roe, the Court had held

that in the second trimester of pregnancy, the state could regulate abortion only in the

interests of the health of the mother; and that it is only after viability (when the fetus

can exist outside the womb on its own or through artificial means) that states are

allowed to actually restrict abortions in the interests of protecting the fetus, i.e.,

potential life. A plurality disagreed with the Roe reasoning in this context and with

the trimester framework upon which it is predicated. Chief Justice Rehnquist and

Justices White and Kennedy instead proposed to apply a new standard of review for

state abortion restrictions: whether the state regulation “permissibly furthers the

State’s interest in protecting potential human life”. They concluded that the Missouri

law’s viability testing requirements did and therefore found that provision to be

constitutional. The plurality put in doubt the whole concept of “viability” as the basis

of determining when the state’s interest in regulating abortion pertains: “we do not

see why the State’s interest in protecting potential human life should come into

existence only at the point of viability, and there should therefore be a rigid line

allowing state regulation after viability but prohibiting it before viability.”

However, because the Missouri law did not limit abortions prior to viability, the

plurality did not believe it was necessary to consider overruling Roe. Also, Chief

Justice Rehnquist stated that the Missouri statute was different from the Texas statute

challenged in Roe -- the latter being a criminal abortion law. The plurality stated that

it was instead modifying and narrowing Roe for application in future cases involving

challenges to the constitutionality of state abortion restrictions.

Justice Scalia wrote a separate concurrence because he believed that the Court

did not go far enough. He would have overruled Roe explicitly. Justice O’Connor,

also a part of the majority, wrote a separate concurrence as well but for different

reasons. She was not ready to go as far as Justice Scalia and overrule Roe; nor was

she prepared to join the plurality and dispense with the trimester framework of Roe

at this time. She stated in concurrence that the trimester system was problematic, but

that there was no need to modify it in Webster because the validity of the Missouri

law’s viability provision could be decided under existing precedent, i.e., Roe and

succeeding decisions. She applied a standard of “undue burden” and found the

restriction to be constitutional: “requiring the performance of examinations and tests

useful to determining whether a fetus is viable, when viability is possible, and when

it would not be medically imprudent to do so, does not impose an undue burden on

a woman’s abortion decision.”

VI. A Shift in Direction: Planned Parenthood of Southeastern

Pennsylvania v. Casey

In 1991, the Court in Rust v. Sullivan upheld on both statutory and constitutional

grounds HHS’ Title X regulations restricting recipients of Federal family planning

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funding from counseling women about the option of abortion.57 This case can better

be described as one involving a challenge to First Amendment free speech rights than

to the constitutionally guaranteed substantive right to an abortion; however,

following its earlier public funding cases (Maher v. Roe and Harris v. McRae) as

precedent, the Court did conclude that a woman’s right to an abortion was not

burdened by these regulations. The Court reasoned that there was no such violation

because the Government has no duty to subsidize an activity simply because it is

constitutionally protected and because a woman is “in no worse position than if

Congress had never enacted Title X.”

Both Webster and Rust energized legislative activity, the former at both the

Federal and state levels, and the latter only at the Federal level. Some of the state

legislative proposals that have become law have been challenged in the courts, e.g.,

Pennsylvania, Guam, Louisiana, and Utah. The Pennsylvania case, Planned

Parenthood of Southeastern Pennsylvania v. Casey, was decided by the U.S.

Supreme Court on June 29, 1992.58 In a highly fractionated 5-4 decision, the Court

reaffirmed the basic constitutional right to an abortion while simultaneously allowing

some new restrictions. Justices O’Connor, Kennedy and Souter wrote the plurality

opinion, and they were joined in part by Justices Stevens and Blackmun. Chief

Justice Rehnquist and Justices White, Scalia and Thomas dissented. The Court

refused to overrule Roe, and the plurality explained at length why it was important

to follow precedent. “The Constitution serves human values, and while the effect of

reliance on Roe cannot be exactly measured, neither can the certain cost of overruling

Roe for people who have ordered their thinking and living around that case be

dismissed.”59 At the same time, the plurality indicated that state laws which

contained an outright ban on abortion would be unconstitutional. Nevertheless, the

Court abandoned the trimester framework articulated in Roe and the strict scrutiny

standard of judicial review of abortion restrictions. Instead, it adopted a new

analysis, “undue burden.” Courts will now need to ask the question whether a state

abortion restriction has the effect of imposing an “undue burden” on a woman’s right

to obtain an abortion. “Undue burden” was defined as a “substantial obstacle in the

path of a woman seeking an abortion of a nonviable fetus.”60

The Court applied this new analysis to the Pennsylvania statute and concluded

that four of the provisions did not impose an undue burden on the right to abortion

and were constitutional. Those provisions upheld were the 24-hour waiting period;

informed consent; parental consent by minors with a judicial bypass; and reporting

requirements. The Court also upheld the “medical emergency” definition under

which other requirements can be waived. The spousal notification provision,

requiring a married woman to tell her husband she intends to have an abortion, did

not survive the “undue burden” test, and it was struck down as being

unconstitutional. The dissenters would have upheld all of the provisions in the

Pennsylvania law as well as overturn Roe itself. Justices Stevens and Blackmun

57

500 U.S. 173 (1991).

58

505 U.S. 833 (1992).

59

Casey, 505 U.S. at 856.

60

Casey, 505 U.S. at 877.

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wrote separate opinions. They joined the plurality in holding the spousal notification

provision unconstitutional. Justice Stevens was vague concerning whether he was

accepting the new “undue burden” analysis, but he did indicate that his application

of it might be more stringent than the plurality’s. On the other hand, Justice

Blackmun stated that he would retain the analysis used in Roe, i.e., strict scrutiny.

The Court’s decision in Casey was significant because it appeared that the new

standard of review would allow more state restrictions to pass constitutional muster.

The decision was also noteworthy because the Court found that the state’s interest in

protecting the potentiality of human life extended throughout the course of the

pregnancy, and thus the state could regulate, even to the point of favoring childbirth

over abortion, from the outset. Under Roe, which utilized the trimester framework,

during the first trimester of pregnancy, the woman’s decision to terminate her

pregnancy was reached in consultation between her and her doctor with virtually no

state involvement. Also, under Roe, abortion was a “fundamental right” that could

not be restricted by the state except to serve a “compelling” state interest. Roe’s

strict scrutiny form of review resulted in most state regulations being invalidated

during the first two trimesters of pregnancy. The “undue burden” standard seems to

allow more regulation during that period. This is evident from the Court’s

overruling, in part, two of its earlier decisions which had followed Roe: City of Akron

and Thornburgh v. American College of Obstetricians and Gynecologists.61 In those

cases, the Court, applying strict scrutiny, struck down 24-hour waiting periods and

informed consent provisions. In contrast, the Court in Casey upheld similar

provisions after applying the undue burden standard.

VII.

Applying Casey: Stenberg v. Carhart

Following Casey, the Court appeared reluctant to review another abortion case.

Between 1992 and 1993, the Court declined to hear appeals in three abortion cases.62

Contrary decisions by the U.S. Court of Appeals regarding the validity of state

statutes prohibiting “partial-birth” abortions, as well as congressional interest in

enacting federal partial-birth legislation may have prompted the Court to decide

Stenberg v. Carhart.63

The term “partial-birth abortion” refers generally to a method of abortion

commonly called “dilation and extraction” or “D & X” by the medical community.

D & X involves the extraction, from the uterus and into the vagina, of all of the body

of a fetus except the head.64 The fetus is then killed by extracting the contents of the

skull, and an intact fetus is delivered.65 D & X is one of several abortion methods.

61

Thornburgh v. American College of Obstetricians and Gynecologists, 476 U.S. 747

(1986).

62

See Ada v. Guam, 113 S.Ct. 633 (1992); Barnes v. Moore, 113 S.Ct. 656 (1992); Barnes

v. Mississippi, 114 S.Ct. 468 (1993).

63

530 U.S. 914, 120 S.Ct. 2597 (2000).

64

See Stenberg, 120 S.Ct. at 2607-8.

65

Id.

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“Dilation and evacuation” or “D & E” is the most common procedure.66 D & E

involves the dilation of the cervix and the dismemberment of the fetus inside the

uterus.67 Fetal parts are later removed from the uterus either with forceps or by

suction. The procedural similarities between the D & X and D & E procedures have

prompted concern that the language of state partial-birth abortion bans may prohibit

both methods of abortion.68

In Stenberg, a Nebraska physician who performs abortions at a specialized

abortion facility sought a declaration that Nebraska’s partial-birth abortion ban

statute violates the U.S. Constitution. The Nebraska statute provides:

No partial birth abortion shall be performed in this state, unless such procedure

is necessary to save the life of the mother whose life is endangered by a physical

disorder, physical illness, or physical injury, including a life-endangering

physical condition caused by or arising from the pregnancy itself.69

The term “partial birth abortion” is defined by the statute as “an abortion procedure

in which the person performing the abortion partially delivers vaginally a living

unborn child before killing the unborn child and completing the delivery.”70 The

term “partially delivers vaginally a living unborn child before killing the unborn

child” is further defined as “deliberately and intentionally delivering into the vagina

a living unborn child, or a substantial portion thereof, for the purpose of performing

a procedure that the person performing such procedure knows will kill the unborn

child and does kill the unborn child.”71 Violation of the statute carries a prison term

of up to twenty years and a fine of up to $25,000. In addition, a doctor who violates

the statute is subject to the automatic revocation of his license to practice medicine

in Nebraska.

Among his arguments, Dr. Carhart maintained that the meaning of the term

“substantial portion” in the Nebraska statute is unclear and thus, could include the

common D & E procedure in its ban of partial-birth abortions. Because the Nebraska

66

Stenberg, 120 S.Ct. at 2606.

67

Id.

68

See Women’s Medical Professional Corporation v. Voinovich, 130 F.3d 187, 199 (6th Cir.

1997), cert. denied, 523 U.S. 1036 (1998) (“The primary distinction between the two

procedures is that the D & E procedure results in a dismembered fetus while the D & X

procedure results in a relatively intact fetus. More specifically, the D & E procedure

involves dismembering the fetus in utero before compressing the skull by means of suction,

while the D & X procedure involves removing intact all but the head of the fetus from the

uterus and then compressing the skull by means of suction. In both procedures, the fetal

head must be compressed, because it is usually too large to pass through a woman’s dilated

cervix. In the D & E procedure, this is typically accomplished by either suctioning the

intracranial matter or by crushing the skull, while in the D & X procedure it is always

accomplished by suctioning the intracranial matter.”).

69

Neb. Rev. Stat. § 28-328(1).

70

Neb. Rev. Stat. § 28-326(9).

71

Id.

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legislature failed to provide a definition for “substantial portion,” the U.S. Court of

Appeals for the Eighth Circuit interpreted the Nebraska statute to proscribe both the

D & X and D & E procedures: “if ‘substantial portion’ means an arm or a leg - and

surely it must - then the ban . . . encompasses both the D & E and the D & X

procedures.”72 The Eighth Circuit acknowledged that during the D & E procedure,

the physician often inserts his forceps into the uterus, grasps a part of the living fetus,

and pulls that part of the fetus into the vagina. Because the arm or leg is the most

common part to be retrieved, the physician would violate the statute.73

The state argued that the statute’s scienter or knowledge requirement limited its

scope and made it applicable only to the D & X procedure. According to the state,

the statute applied only to the deliberate and intentional performance of a partial birth

abortion; that is, the partial delivery of a living fetus vaginally, the killing of the

fetus, and the completion of the delivery.74 However, the Eighth Circuit found that

the D & E procedure involves all of the same steps: “The physician intentionally

brings a substantial part of the fetus into the vagina, dismembers the fetus, leading

to fetal demise, and completes the delivery. A physician need not set out with the

intent to perform a D & X procedure in order to violate the statute.”75

The Supreme Court affirmed the Eighth Circuit’s decision by a 5-4 margin. The

Court based its decision on two determinations. First, the Court concluded that the

Nebraska statute lacks any exception for the preservation of the health of the mother.

Second, the Court found that the statute imposes an undue burden on the right to

choose abortion because its language covers more than the D & X procedure.

Despite the Court’s previous instructions in Roe and Casey, that abortion

regulation must include an exception where it is “necessary, in appropriate medical

judgment, for the preservation of the life or health of the mother,” the state argued

that Nebraska’s partial-birth abortion statute does not require a health exception

because safe alternatives remains available to women and a ban on partial-birth

abortions would create no risk to the health of women.76 Although the Court

conceded that the actual need for the D & X procedure is uncertain, it recognized that

the procedure could be safer in certain circumstances.77 Thus, the Court stated, “a

statute that altogether forbids D & X creates a significant health risk . . . [t]he statute

consequently must contain a health exception.”78

In its discussion of the undue burden that would be imposed if the Nebraska

statute was upheld, the Court maintained that the plain language of the statute covers

72

Carhart v. Stenberg, 192 F.3d 1142, 1150 (8th Cir. 1999).

73

Id.

74

Carhart, 192 F.3d at 1150.

75

Id.

76

Stenberg, 120 S.Ct. at 2610 (quoting Roe, 410 U.S. at 164-65).

77

Stenberg, 120 S.Ct. at 2613.

78

Id.

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both the D & X and D & E procedures.79 Although the Nebraska State Attorney

General offered an interpretation of the statute that differentiated between the two

procedures, the Court was reluctant to recognize such a view. Because the Court

traditionally follows lower federal court interpretations of state law and because the

Attorney General’s interpretative views would not bind state courts, the Court held

that the statute’s reference to the delivery of “a living unborn child, or a substantial

portion thereof” implicates both the D & X and D & E procedures.80

Because the Stenberg Court was divided by only one member, Justice

O’Connor’s concurrence has raised concern among those who support a woman’s

right to choose. Justice O’Connor’s concurrence indicates that a state statute

prohibiting partial-birth abortions would likely withstand a constitutional challenge

if it includes an exception for situations where the health of the mother is at issue,

and if it is “narrowly tailored to proscribing the D & X procedure alone.”81 Justice

O’Connor identifies Kansas, Utah, and Montana as having partial-birth abortion

statutes that differentiate appropriately between D & X and the other procedures.82

Justice O’Connor’s identification of these state statutes suggests her willingness to

find partial-birth legislation constitutional if it meets the required criteria.83

79

Stenberg, 120 S.Ct. at 2614.

80

Stenberg, 120 S.Ct. at 2616.

81

Stenberg, 120 S.Ct. at 2619. See also Stenberg, 120 S.Ct. at 2620 (“If there were adequate

alternative methods for a woman safely to obtain an abortion before viability, it is unlikely

that prohibiting the D & X procedure alone would ‘amount in practical terms to a substantial

obstacle to a woman seeking an abortion’ [citation omitted] . . . Thus, a ban on partial-birth

abortion that only proscribed the D & X method of abortion and that included an exception

to preserve the life and health of the mother would be constitutional in my view.”).

82

83

See Stenberg, 120 S.Ct. at 2619.

See also Jon O. Shimabukuro, Partial-Birth Abortion: Recent Developments in the Law,

CRS Report RL30415 (2001).

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.

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