Fact Sheet - Planned Parenthood

Fact Sheet: Women’s Health Care Restrictions
Updated: September 12, 2011
Background
In 2009, the Abortion Omnibus Bill, House Bill 2564, set out to change many of the laws and
regulations in place regarding access to abortion care. The bill:
• mandated information to be read to a patient by a physician, in-person, 24 hours before
the abortion (despite the fact that health care providers already give full informed
consent, in person, on the day of the woman’s appointment);
• required that parental consent for minor’s access to abortion services be notarized
(despite the fact that the notarization may compromise the confidentiality of minors and
their families);
• prohibited nurse practitioners from performing first trimester surgical abortion (despite
the fact that the Arizona Board of Nursing already determined that nurse practitioners can
safely provide this service);
• and, allowed all health care workers, including pharmacists, to refuse to provide
information for or access to, abortion care and birth control, including emergency
contraception because of personal or religious objections, even in a medical emergency.
In 2011, conservative legislators and The Center for Arizona Policy introduced House Bill 2416
and Senate Bill 1030, putting additional restrictions on women’s health care.
• SB1030 further limited who among trained professionals can provide abortion care by
stating that nurse practitioners and physician assistants cannot dispense abortion-by-pill;
this care must be provided by a physician.
• HB2416 expanded the definition of an abortion facility to include provision of abortionby-pill,
applying unnecessary regulations to abortion-by-pill. The bill also imposed a
mandatory one-hour waiting period after a woman has her ultrasound and before abortion
care can begin, and bans telemedicine in the case of abortion-by-pill.
Timeline
July 13, 2009 - Governor Brewer signs HB2564 into law. The law is set to go into effect on
September 30, 2009.
September 14, 2009 - Planned Parenthood Arizona files a lawsuit, challenging key pieces of the
anti-choice, anti-women’s health care bill. A preliminary injunction is granted on September 29,
2009, keeping some of the most harmful pieces of the new law from going into effect.
April 2, 2011 – Governor Brewer signs HB2416 into law. The law is scheduled to go into effect
on July 20, 2011.

June 14, 2011 - The Court of Appeals hears arguments on whether the preliminary injunction
should remain in effect while the lawsuit continues over the provisions set in the 2009 law.
June 29, 2011 – Planned Parenthood Arizona files a lawsuit challenging the constitutionality of
the provisions set in HB2416 and SB1030.
July 6, 2011 – The challenged provisions from HB2416 and SB1030 are stayed and are not to go
into effect until after a hearing, scheduled for September 12.
August 11, 2011 - The Court of Appeals remands the preliminary injunction for HB2564.
August 16, 2011 - Planned Parenthood Arizona withdraws its request for a preliminary
injunction related to HB2416 and SB1030
August 18, 2011 – The enjoined provisions from HB2416 and SB1030 are put into place at
Planned Parenthood Arizona’s health centers. With limited trained physicians available to
provide services, three of the original ten health centers that provided abortion (by-pill or inclinic)
will continue to provide abortion care. Abortion care is now only available in the Valley
of the Sun and Tucson.
September 12, 2011 – The previously enjoined provisions from HB2564 are put into place at
Planned Parenthood Arizona’s health centers and other abortion providers in Arizona. Other
abortion providers will also need to be compliant with the provisions set in HB2416 and SB1030.
Basis for the 2009 Injunction
This portion of the law violates the Arizona Constitution, by infringing on the Right to Equal
Privileges and Immunities and Right to Privacy guaranteed by the Arizona Constitution.
In Simat v. Arizona Health Care Cost Containment System 1 , the Arizona Supreme Court
recognized that under Arizona’s constitution, laws that restrict abortion are subject to strict
scrutiny, meaning that the restrictions can survive only if they are narrowly tailored to serve a
compelling state interest. This is a higher level of scrutiny than abortion restrictions are given
under the federal constitution.
In Rasmussen v. Fleming, the Arizona Supreme Court recognized that under the privacy
provision of the Arizona Constitution: “An individual’s right to chart his or her own plan of
medical treatment deserves as much, if not more, constitutionally-protected privacy than does an
individual’s home or automobile.” i
Below are the provisions of the law that were enjoined in September 2009 and will go into
effect on September 12, 2011:
Forced Lecture & Imposed Waiting Periods
1 Simat Corp. v. Arizona Health Care Cost Containment System, 203 Ariz. 454 (2002).

While many other states have mandatory counseling laws, Arizona’s is one of the most extreme
in the country. Only a very small number of states force women to make two trips, in person, 24
hours apart, to receive information from a physician. Planned Parenthood did not challenge the
mandatory counseling law itself, only the requirement that the information come from a
physician and in person.
o This 24-hour waiting period took effect on October 1, 2009.
o The Preliminary Injunction granted in 2009, held that the forced lecture did not need to
take place in person, thereby avoiding the need to force patients to make two trips
(sometimes of hundreds of miles) to the health center. Previously the mandatory
information was provided to patients over the phone by a trained medical provider.
o Women will now have to adhere to the two-trip requirement so they can receive the state
mandated information from a physician in-person.
o The two-trip requirement is especially burdensome to rural and poor women, who may
not be able to take extra days off from work, travel long distances, or find appropriate
childcare while they are away from home.
o Independent of HB2564, Planned Parenthood has always provided women with thorough
informed consent before any procedure, including abortion. This is required by the
standards of the medical profession, as well as state laws.
o HB2416 imposed an additional mandatory waiting period for women. A woman is now
required to wait one hour after her ultrasound before abortion-by-pill or in-clinic abortion
can occur.
Parental Consent
Requiring notarized parental consent for abortion creates an undue barrier for young women and their
families trying to access health care, and puts the confidentiality of their decision at risk.
o Parents or guardians of a minor seeking abortion care will now have to have their
signatures notarized by a notary public.
o For a young woman under 18 years of age in Arizona to receive an abortion, she was
already required to obtain the written consent of a parent or guardian. This consent had
to be presented to the health care provider. That requirement was not at issue in the
original lawsuit.
o The notarization requirement does not have strong enough protections for the
confidentiality of this very private decision by a minor and her family.
Providers:
Physicians are now the only medical providers who can provide abortion – by-pill or in-clinic –
in the state of Arizona, and are also required to do other ancillary tasks related to abortion care.

Advanced practice clinicians, such as nurse practitioners, certified nurse midwives, and
physician assistants, have been providing surgical abortions with impressive safety records for
more than three decades.
The Arizona Board of Nursing specifically determined that nurse practitioners can safely provide
this service. Advanced practice clinicians are competent women’s health care providers. The
specialized training for an advanced practice clinician distinction includes graduate education,
supervised clinical training, licensing, and national board certification.
o The scope of practice already identified by the Arizona State Board of Nursing
includes a variety of complex procedures considered as invasive or more so than
surgical abortion, including:
• Intrauterine device (IUD) insertions and endometrial biopsies, colposcopy,
cryotherapy, and the loop electrosurgical excision procedure (LEEP),
peripherally-inserted external jugular catheter, lumbar puncture, bone
marrow aspiration and biopsy.
o The full continuum of care provided by gynecological nurse practitioners ranges
from (a) annual gynecological exams to (b) birth control dispensing to (c) disease
testing and treatment to (d) cancer detection and treatment. Surgical abortion fits
squarely within this continuum of care.
o On May 14, 2008 the Arizona Board of Nursing ruled that performing first
trimester aspiration abortion is within the scope of practice of a properly trained
nurse practitioner.
o The American Public Health Association supports the provision of first trimester
medical and surgical abortion by appropriately trained NPs, CNMs, and PAs. ii
o The National Association of Nurse Practitioners on Women’s Health “believes
that nurse practitioners, with appropriate preparation and medical collaboration,
are qualified to perform abortions.” iii
Provider Refusal:
HB 2564’s provider refusal language is one of the most extreme in the country, making it more
difficult for a woman to find health care professionals who will provide her with complete and
accurate information and medical services when she needs them.
o The provision allows pharmacists and other health professionals and employees to refuse
to provide birth control, and emergency rooms can refuse to even give rape victims
information about emergency contraception based on moral or religious grounds.
o This regulation disrupts Arizona’s health care delivery system at a time when more and
more families are uninsured and under economic assault, fueling our health care crisis by
denying women’s access to quality, affordable basic care.

This part of the law jeopardizes a patient’s right to know all her options by allowing providers to
withhold critical health care services and information women need to make fully informed
decisions about their health care, based on their personal beliefs; which means patients may not
even be aware that they are not getting complete information. There are already federal and state
laws in place that protect medical professionals.
Definitions:
o Abortion-By-Pill - The abortion pill is a medication that ends an early pregnancy. In
general, it can be used up to 63 days — nine weeks — after the first day of a woman's
last period. The name for "the abortion pill" is mifepristone. It was called RU-486 when
it was being developed. Medication abortion involves taking two pills – the first dose is
taken in a medical provider’s office and the second is taken at the patient’s home. It is not
available by prescription.
o In-Clinic Abortion – Also known as surgical abortion, this type of abortion is an outpatient
procedure and is an option for women who are nine weeks pregnant or later. This
procedure requires a surgical suite and recovery room.
i Rasmussen, 154 Ariz. at 216, quoting Schloendorff v. Society of New York Hospital, 211 N.Y. 125, 129 - 130, 105 N.E. 92, 93 (1914).
ii APHA Resolution No. 9917, 1999.
iii NANPRH Resolution no Nurse Practitioners as Abortion Providers, October 1991.