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Should S.C. Require An Ultrasound Before An Abortion?

The Department of Health and Environmental Control isn’t doing a good enough job overseeing the state’s three abortion clinics, according to a new state audit.

But the audit goes a step further, actually recommending that legislators pass a law requiring an ultrasound before an abortion. And that recommendation could put auditors in the midst of a heated policy argument.

The report came at the request of a group of conservative S.C. House members who asked that the state auditor, a small agency called the Legislative Audit Council, look into DHEC’s regulation of abortion clinics.

The overwhelming majority of abortions performed in South Carolina — 99 percent, according to the audit — are performed at the three abortion clinics in the state. Only first-trimester abortions can be performed in a clinic; second-trimester abortions must be done in a hospital, and abortions after the second trimester are illegal in South Carolina. The number of abortions has been dropping, with 5,708 last year statewide, down from 6,911 five years earlier.

Among the report’s findings: DHEC only performed 33 inspections since 2001, short of the required 42; information for abortion patients on DHEC’s website is outdated; and DHEC isn’t tracking abortions adequately, as clinics’ own records show more abortions than DHEC’s records.

DHEC disputes some of the audit’s findings, saying some of the information it submitted was ignored.

In addition to recommending that DHEC improve oversight and training, the audit recommends that state legislators pass a law requiring an ultrasound before an abortion, saying it’s a more reliable method of determining the age of a fetus than a physical exam and calendar.

No evidence is given in the report suggesting that clinics are making errors when it comes to gestational age.

The Guttmacher Institute, a pro-choice policy group, has criticized the idea that ultrasounds should be required by law.

“Since routine ultrasound is not considered medically necessary as a component of first-trimester abortion, the requirements appear to be a veiled attempt to personify the fetus and dissuade a woman from obtaining an abortion,” the group said in a recent report. “Moreover, an ultrasound can add significantly to the cost of the procedure.”

What’s more, before 14 weeks of pregnancy, it’s common for ultrasounds to be done with a probe inserted into the vagina, rather than on the outside of the woman’s belly. In 2012, when Virginia lawmakers tried to propose a law requiring what’s sometimes called a transvaginal ultrasound prior to an abortion, they ran into a firestorm of public outrage.

At least two of the three abortion clinics in the state already do an ultrasound before an abortion. The third clinic couldn’t be reached for comment.

To come up with its recommendation, the Legislative Audit Council reviewed the laws of nearby states — Alabama, Florida, Georgia, Mississippi and North Carolina.

“We found that, with the exception of Georgia, which does not have abortion clinics, these states have laws requiring an ultrasound prior to all abortions in order to establish the gestational age of the fetus,” the audit reads. “Additionally, we reviewed several articles on the accuracy of ultrasound as a method for establishing the gestational age of the fetus. These articles conclude that ultrasonography is more accurate than establishing the gestational age of the fetus by means of the woman’s last menstrual period and/or bimanual examination by a physician.”

It’s well within the agency’s purview to make such recommendations, says Marcia A. Lindsay, deputy director of the Legislative Audit Council and the manager for the audit.

“Yes, we are supposed to make recommendations to the agency itself, and then if we feel like any laws need to be amended, we definitely make those recommendations to the General Assembly,” Lindsay says. “That is standard procedure in all of our audits.”

But a spokeswoman for Planned Parenthood, which runs the Midlands abortion clinic, notes that the report wasn’t written by medical professionals.

The request to have the audit done in the first place was “another way to chip away at access” to abortions, says Planned Parenthood’s Alyssa Miller.

“This was just another attempt to try and interfere with the procedure and with women’s health,” says Miller. “I think it was a purely political move.”

“Abortion is already one of the most heavily regulated medical procedures in the nation, and it’s also one of the safest,” she added.

However, GOP Rep. Donna Hicks, one of the lawmakers who requested the report, says it wasn’t political at all.

“The bottom line is I want to make sure women’s health is No. 1,” Hicks says. “Anytime you perform a procedure on someone, it puts that person at a certain amount of health risk.”

Asked about whether she’d push for a state law requiring an ultrasound, Hicks says she’d consider it, if only to make sure state law lines up with what clinics are already doing.

“My big thing is I’m not out to get anybody,” Hicks says. “But what this audit has revealed is DHEC hasn’t done their part in looking at abortion clinics and making sure things are being done properly.”

“My plan is, once I look at all this, is to call on the governor to make sure her cabinet agency is doing what they’re supposed to do.”