It happens almost daily in Michigan: abortion patients getting turned away from their scheduled appointments, because there’s a problem with their state-mandated paperwork.
“Pretty much every single day that I provide care, somebody’s care is not able to happen because of complications of that 24-hour consent process,” said Dr. Lisa Harris, an obstetrician-gynecologist and professor of reproductive health at the University of Michigan.
She’s talking about two of the current restrictions on abortion that remain in Michigan, even after Proposal 3 enshrined abortion rights in the state Constitution last year: 1) a mandatory 24-hour wait period, and 2) a signed “informed consent” form testifying the patient has reviewed required material about the procedure.
In practice, the two have been combined into a single form, accessible only through a state website, that patients must sign within a specific time frame (no more than two weeks, but no less than 24 hours, before their appointment), print and bring to their appointment.
If they don’t, or if they fill the form out incorrectly, the appointment can’t proceed. That happens to at least 150 patients each month at Planned Parenthood of Michigan clinics alone, according to PPMI.
Last week, Democrats in Lansing introduced the Reproductive Health Act, a package of bills that would repeal numerous abortion restrictions in the state, including the 24-hour mandatory waiting period and the informed consent form.
Doing so would remove barriers that providers say are burdensome complications which frequently lead to medically unnecessary delays in care, but abortion rights opponents say are important safeguards.
Why patients are being turned away
On the face of it, it sounds pretty straightforward: Sign a form at least 24 hours before your appointment. Bring that form to your appointment.
But abortion providers say it’s more complicated than that.
First, patients have to access an online consent form on the state health department’s website. State law requires that form include specific information about abortion coercion, parenting and prenatal care, and an illustrated pamphlet showing weekly fetal development. (“MDHHS does not necessarily endorse all the information it is required to make available under this statute,” the site reads.)
Then there’s a second page for the patient’s signature, where the patient must attest they have “reviewed each of the following:
- A medically accurate depiction, illustration, or photograph of a fetus at the probable gestational age of the fetus I am carrying
- A written description of the medical procedure that will be used to perform the abortion.
- A prenatal care and parenting information pamphlet.
- A prescreening summary on prevention of coercion to abort."
A date and time stamp is automatically generated at the bottom, stating that “an abortion cannot be performed before” at least 24 hours later, and that the form will expire after two weeks. Patients must then print and bring the form to their appointment, where clinic staff are required to check the time stamp.
“Despite our best efforts to let people know about the 24-hour mandated delay and how to complete the paperwork, patients are still turned away on a near daily basis,” said Ashlea Phenicie, a spokesperson for Planned Parenthood of Michigan, in an email.
“Based on our records, we estimate this impacts an average of 150 patients each month. We tell patients about it when they schedule the appointment (both through our call center and online) and we make reminder calls, but it isn’t enough. People may not read the instructions thoroughly, they may not have access to a printer or wi-fi, they may miss the time window, they may forget the paperwork at home . . . the list goes on. Every day this impacts care.”
And rescheduling an abortion isn’t easy. Michigan clinics are often booking out several weeks in advance, as demand from out-of-state patients has increased significantly.
Patients “likely had to make child care arrangements and work arrangements or travel arrangements,” Harris said. “And then there may not be an appointment the next day. So sometimes a paperwork delay results in a delay that could be days, or sometimes even weeks before someone is able to get back. So people's abortions happen later than they intended to. And it raises lots of complications for their life.”
Because the informed consent form expires after two weeks, patients who do have to reschedule after that time frame could find themselves right back where they started if they don’t print a new form.
“It’s a tricky window because it has to be at least 24 hours, but it can't be more than two weeks,” Harris said. “We see people running into this as well. Let's say they come in with their 24-hour consent, and we assess them and we realize, ‘Oh, there's a medical issue here that needs to be carefully assessed before we can decide if this care can safely happen in an outpatient setting.’”
But when patients return, “it’s outside now the two-week window, and…that [original] 24-hour consent no longer counts anymore. And then they have to start a new process. And it’s just a lot of burden for patients.”
Would removing restrictions lead to rushed abortions?
But abortion rights opponents say stripping the state’s 24-hour mandatory waiting period and informed consent requirements puts patients at greater risk of getting a procedure they don’t fully understand or aren’t certain about.
“The idea that you should be able to just walk in and have an abortion on the spot, without having time to digest all of that information that you're supposed to get from informed consent, it really seems like a violation of the standard of care,” said Genevieve Marnon, legislative director for Right to Life of Michigan.
“Informed consent can look different for different procedures, but it exists for every procedure… And there are no other procedures that you can get by walking in the door, right then and there. You try and schedule any surgery, it's going to be way more than 24 hours before you get in.”
But abortion providers would still have to follow legal and ethical guidelines requiring informed consent, even if the abortion-specific requirements were repealed. The American Medical Association’s Code of Medical Ethics requires caregivers inform patients about “the nature and purpose of recommended interventions; the burdens, risks, and expected benefits of all options, including forgoing treatment.” It also requires health care providers “document the informed consent conversation and the patient’s (or surrogate’s) decision in the medical record in some manner.”
“All medical care requires informed consent and after the RHA passes, we will continue to talk to patients about their care options, the risks and benefits, reasonable alternatives including the risks and benefits of the alternatives, and an assessment of the patient’s understanding of the discussion,” Phenicie said.
She also pointed to several studies suggesting that mandatory waiting periods for abortions are unhelpful and potentially even harmful for patients. One study of 500 Utah patients found most said their “certainty remained unchanged” over the course of the state’s 72-hour waiting period. Another study, published in the journal Obstetrics and Gynecology in 2021, found that “decision certainty is relatively high and stable over time among those who had had an abortion,” and that “living in a state with a waiting period or two-visit requirement is not associated with increased decision certainty.”
“As a care provider, the main thing I want is that a person is only ending a pregnancy if this is the correct decision for them,” said Harris, the University of Michigan obstetrician-gynecologist. “The state paperwork process is not needed to make sure that that happens.
“…Most days where I'm seeing patients, someone after talking to us does decide that they want more time, or they do decide that they want to continue the pregnancy. And they leave. And they can do that. It's not that the abortion happens as soon as they walk into the care center. So there's so many sorts of guardrails and backstops through the care process, that the paperwork doesn't add to at all.”