The effect of women’s right to know law on abortion providers in North Carolina
Awarded 2013
Small Research Grants
Rebecca Mercier, MD, MPH
University of North Carolina, Chapel Hill

Objectives: In 2011, North Carolina passed the Women’s Right to Know Act (WRTK) that mandated a 24-hour waiting period and state-scripted counseling prior to abortion. We performed a study to investigate and describe the experience of abortion providers following implementation of this law. Methods: We conducted semi-structured interviews with 31 individuals involved with abortion provision in North Carolina. We interviewed 17 physicians, 9 nurses, 1 physician assistant, 1 counselor, and 3 clinic administrators. Interviews were audio-recorded and transcribed. Interview transcripts were analyzed using a grounded theory approach. Themes related to the provider experience were identified with attention to institutional effects, provider and patient emotional response, perceived impact on the patient-physician relationship, and ethical conflicts. Results: Most providers reported that their practice was affected by passage of the law, and describe the law in negative terms. Providers described multiple alterations in clinic practices to comply with regulations while simultaneously minimizing barriers for patients. The aspect of the law most troubling for many providers was performing the state-mandated counseling. Providers felt that biased language and inappropriate content in counseling could interfere with trust in the provider-physician relationship, though they developed strategies to mitigate the practical and emotional impacts for the patients. Providers also identified multiple areas of ethical concern, including issues related to confidentiality, patient autonomy, and non-maleficence. Conclusions: Abortion providers are significantly impacted by the WRTK regulation. Providers expend resources to minimize the impact on patients. Scripted counseling may interfere with the therapeutic relationship, and is associated with several ethical concerns.