Explained: Why AZ doctors are fighting these abortion rules in court right now

You may remember that last November, Arizona voters approved Prop 139 to protect abortion rights in the state constitution. But a year later, several old restrictions are still on the books—and doctors say they’re making it unnecessarily difficult for patients to get care.

That’s why OB-GYNs and the Arizona Medical Association went to court in May to argue that Prop 139  makes several abortion care restrictions unconstitutional.

Dr. Misha Pangasa, an OB-GYN and abortion provider with the Committee to Protect Health Care, explained how these restrictions create real barriers for her patients.

You can’t get abortion pills through telemedicine

Arizona is one of only four states that bans people from receiving abortion medication via telemedicine or getting pills mailed to them.

“We know [telemedicine] is a safe way to provide more access to people who can’t travel all the way to a clinic and people who can’t make a specific appointment time,” Pangasa said.

Telemedicine would open the door for people who need to pick up their kids from school, or who have jobs at times when they’re unable to get to a clinic.

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It would be especially helpful for people who live hours away from the limited in-person clinics throughout the state. Arizona has nine in-person abortion providers. Six in Maricopa County, one in Flagstaff, and two in Tucson.

“Telemedicine abortion won’t be for everybody,” Pangasa said. “There are definitely patients who have irregular periods or are just worried and really want the in-person appointment, which is absolutely reasonable.

“The goal in being able to provide [telemedicine care] is not to make it the sole option for people, but to just increase the number of options that people have to access the care they need,” she added.

You need two separate clinic visits—24 hours apart

Even for an early medication abortion that’s simply taking two pills, Arizona law requires patients to come to a clinic twice, with at least 24 hours between appointments.

Pangasa said patients often beg her to provide the abortion immediately, but she has to say no because of the restrictive law.

For someone living in rural Arizona, this means either staying overnight near the clinic or making two separate round-trip drives—which can add more than six hours of driving and hundreds of dollars in gas, lodging, childcare, and lost wages.

Doctors can’t help patients who learn their fetus has a genetic abnormality

Arizona law prohibits doctors from providing an abortion if they know or suspect a patient is making that choice because the fetus has a genetic abnormality, like a heart defect or cystic fibrosis.

“The idea of receiving a devastating diagnosis in a pregnancy that somebody is incredibly excited about is a really devastating thing to undergo,” Pangasa said. “To take care of those patients is particularly heartbreaking.”

“I have to tell them their expertise in their life, expertise in their family and difficult decision making isn’t enough for Arizona,” she said. “It’s not only heartbreaking…it’s quite frankly just true cruelty on the part of Arizona.”

“It’s creating stigma and shame in a situation for patients that is already so taxing and so difficult. I just think that particular element of legislation is one of the most cruel things that I’ve seen from the state.”

You must listen to a government-written script

Before providing an abortion, Arizona doctors are legally required  to recite specific information, written by the state legislature, to a patient in person. As part of this script, they are legally required to tell a patient things that aren’t medically motivated, but rather ideologically or politically motivated.

“First of all it’s superfluous because the basic component of any health care encounter is informed consent,” Pangasa said. “Additionally, it removes that sort of normal relationship and conversation that you’re able to have with a patient.”

Doctors know what they have to talk about with a patient, and they know the risks and benefits of different forms of abortion, whether it’s a surgical or medication abortion.

“When I am forced to talk through a specific checklist created by the state, it just removes that element of the relationship between a physician and a patient,” Pangasa said.

She added that doctors already talk about options for choosing to either continue or terminate a pregnancy, along with the medical risks and benefits of each option.

“We do all of those things and then we also have this script that is basically written by the government that is designed to shame you in this decision,” Pangasa said.

You’re required to get an ultrasound—even when it’s not medically necessary

At least 24 hours before an abortion, a patient must undergo an ultrasound and be given the chance to look at the image and hear a description of what’s shown.

On the surface, a mandatory ultrasound might seem reasonable. But Pangasa says that it’s not always medically necessary.

“Not every patient needs an ultrasound prior to getting abortion care,” Pangasa said. “There’s a robust amount of evidence and research about patients’ ability to self-assess how far along they are in pregnancy based on having regular periods. Many people know exactly when they conceived.”

For patients who’ve received a devastating fetal diagnosis, being forced to look at ultrasound images can be especially cruel. Pangasa said it’s just another way to force people to go to a physical place where they need to have an ultrasound, and it serves as yet another obstacle.

“Certainly if people have irregular periods or are very uncertain about when they conceived or have significant risk factors for an ectopic pregnancy, those are people who we would still recommend to have an ultrasound,” Pangasa said.

“The idea in removing these restrictions is not to say this is a one size fits all approach for everybody,” she said. “It’s to provide true person-centered care, and to be able to talk to an individual person about their life, their health, their circumstances, and then provide safe options for them.”

What happens next?

Judge Greg Como heard three days of testimony in November this year, and indicated he may issue a ruling that permanently blocks these restrictions. As of early December, he hasn’t made his decision.

Arizona Attorney General Kris Mayes has declined to defend the abortion obstacle laws, and has sided with the doctors challenging them. Republican legislative leaders, including Senate President Warren Petersen and House Speaker Steve Montenegro, are defending the restrictions in court.

If the judge rules in favor of the doctors, the restrictions would be struck down and Arizonans would have fuller access to the abortion rights they voted for in Prop 139.