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Reporters & Editors,

You may have recently seen some anti-abortion groups and lawmarkers put out claims about the New Hampshire budget’s impact on reproductive health care. Below we hope to answer any questions you may have on this cruel anti-abortion budget.

The budget just signed into law by Governor Sununu bans abortion at 24 weeks with virtually no exceptions, including none for fatal fetal diagnoses, rape, or incest. In addition, the budget mandates ultrasounds to determine gestational age at all stages of pregnancy. Generally, in the first trimester, a transvaginal ultrasound is necessary to determine gestational age. 

Section 39 of HB 2 states: “Except in the case of a medical emergency as specifically defined in paragraph III, no abortion shall be performed, induced, or attempted by any health care provider unless a health care provider has first made a determination of the probable gestational age of the fetus… the health care provider shall conduct an obstetric ultrasound examination of the patient for the purpose of making the determination.”

This provision creates additional barriers to abortion care at all stages of pregnancy.

Are ultrasounds always performed before providing abortion care?

While ultrasounds are performed in some circumstances, they may be unnecessary for some patients accessing abortion. This is especially true for medication abortion, which is a safe and effective way to terminate a pregnancy at early gestations, accounting for about 39 percent of all abortion care nationally. Requiring an ultrasound to obtain a medication abortion creates unnecessary barriers to abortion access, including transportation and cost.

Does this law require a transvaginal ultrasound?

This act requires an ultrasound before all abortion care to determine gestational age. In the earliest stages of pregnancy, a transvaginal ultrasound is necessary to meet that requirement. This ultrasound mandate will most impact patients seeking medication abortion, which can be used up to 11 weeks of pregnancy. For abortion care after 11 weeks, an abdominal (or pelvic) ultrasound is generally used. According to The American College of Obstetricians and Gynecology, “For patients with regular menstrual cycles, a certain last menstrual period within the prior 56 days, and no signs, symptoms, or risk factors for ectopic pregnancy, a clinical examination or ultrasound examination is not necessary before medication abortion.” With this new provision, however, an ultrasound will be required to access abortion care.

Will the law’s ultrasound requirement be costly?

It will depend on whether a patient has insurance. According to the New Hampshire Insurance Department, for patients who do not have insurance the statewide estimate of cost for an ultrasound is $404. The amount a patient will need to pay ranges from $83 to $1,015 depending on location. 

For patients who have insurance, Commissioner Nicolopoulos stated in the June 30th Executive Council meeting (2:41:30) that insurance would need to cover these ultrasounds, regardless if they are medically necessary, because of the new state mandate. Governor Sununu confirmed that “a mandate’s a mandate.” On July 1, 2021, the Department issued a bulletin confirming that insurers must cover the ultrasound. This additional mandate could drive up insurance premiums. 

In short, patients who do not have insurance, and already need to pay for care out-of-pocket, will also need to pay for this often unnecessary procedure. 

Why does this law require ultrasounds?

Requiring ultrasounds prior to all abortion care is intended to shame patients. During the Committee of Conference, a state representative advocating for this provision explained that “ultrasound images can be useful to that mother to connect to the baby that’s inside of her so that she’s better able to make a decision as is whether she wants to go forward with the procedure.” This type of statement makes clear that some New Hampshire lawmakers do not trust patients to make their own health care decisions in consultation with their providers.

The Committee of Conference members chose not to remove the ultrasound provision after this explanation.

Let’s be clear: mandating ultrasounds adds an unnecessary and costly barrier to accessing abortion; it serves no medical advantage to the patient but may shame and/or stigmatize the patient. 

Do other states have 24-week abortion bans?

Although other states may ban abortion at 24 weeks, the New Hampshire ban has only one narrow exception for maternal physical health. There is no exception for rape, incest, or fatal fetal anomalies, making the New Hampshire ban even more extreme and an outlier.  Additionally, New Hampshire’s ban carries a class B felony charge for health care professionals, which includes up to seven years in prison and a fine of up to $100,000. There are no other medical procedures in New Hampshire law subject to felony charges and imprisonment for health care professionals. 

Does this ban contain an exception for fetal anomalies? 

No. A person who discovers a fatal fetal anomaly and needs abortion care after this ban’s arbitrary 24-week cutoff would be forced to carry the pregnancy to term, up to 16 more weeks. Massachusetts, which Governor Sununu has used as a comparison, does have an exception for fatal fetal anomalies.

Does this ban contain an exception for rape or incest?

No. Survivors of sexual assault deserve compassion and respect, not arbitrary timetables dictating when they can access abortion.

Does the ban impose felony penalties?

Yes. Health care providers are threatened with a class B felony charge if they perform an abortion at 24 weeks.

Will this ban punish abortion providers who are “just doing their jobs”?

Yes. Health care providers face up to seven years in prison and a fine of up to $100,000.

Is there any other reason the ban is considered “extreme”? 

The ban is extreme for many reasons. To name a few, this ban has no exception for fatal fetal anomalies; no exception for rape; no exception for incest; a very narrow exception for maternal physical health; criminalizes health care providers with a class B felony; mandates ultrasounds prior to all abortion care; allows husbands to file civil actions; and allows the patient’s parents to file civil actions.

But this ban is also extreme because it goes against the broad bipartisan support for abortion access here in New Hampshire. 66 percent of Granite Staters believe that abortion should be legal in all or most cases, and there is no state where banning abortion is popular. A set of surveys out of the Harvard T.H. Chan School of Public Health show that a majority of adults support women having access to abortion after 24 weeks when given context. The research also illuminates that people may not know why women seek abortion care later in pregnancy, likely because these stories are not often shared publicly and the situations are so complex.

This ban is in direct opposition to the Granite State values of privacy and personal freedom. 

Is “Plan B” (or the morning after pill) the same thing as an abortion pill?

Absolutely not. While this was suggested recently on the Senate floor, the truth is very simple: Plan B prevents a pregnancy from happening by delaying or stopping ovulation after unprotected sex. It can only be taken before someone is pregnant, and must be taken within 120 hours. The abortion pill terminates a pregnancy. Patients can be up to 11 weeks into pregnancy for a medication abortion. 

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Planned Parenthood of Northern New England (PPNNE) is the largest provider of reproductive and sexual health care for women, men and young people across the State of New Hampshire. We serve New Hampshire residents through 6 health centers in Claremont, Derry, Exeter, Keene, Manchester and White River Junction, VT. In 2020, we saw nearly 11,000 patients at these sites.

Planned Parenthood New Hampshire Action Fund (PPNHAF) is an independent, nonpartisan, not-for-profit organization formed as the advocacy and political arm of Planned Parenthood of Northern New England in New Hampshire. The Action Fund engages in educational and electoral activity, including voter education, grassroots organizing, and legislative advocacy.