So why did a measure in Virginia spark huge protests, police in riot gear and signs that read "Governor McDonnell, get out of my vagina"?
One reason might be that the Virginia debate comes after a record year of abortion laws at the state level: 24 states enacted in 2011 a total of 92 new provisions that restricted abortion, says Elizabeth Nash, the state issues manager at Guttmacher Institute, which supports abortion rights and tracks state developments, including on ultrasound requirements. "People realize this is an intrusion," she says.
Virginia had been considering a measure similar to a 2011 Texas law that went into effect just a few weeks ago after a legal challenge. Texas now requires women seeking an abortion get an ultrasound and be able to see the image and hear the fetal heartbeat. But to get a clear image and be able to pick up the heartbeat early in a pregnancy, experts say there is only one kind of ultrasound that can do that, requiring a wand-like probe inserted into the vagina. Similar measures are on hold by the courts in North Carolina and Oklahoma.
Governor Bob McDonnell said he didn't realize that when he said he supported the measure. So he asked and lawmakers agreed to make clear that the state requires only an external, abdominal ultrasound. And if the doctor thinks the other ultrasound is needed, the state would not have a role in that decision. The governor signed the bill Wednesday (March 7).
Ultrasounds can determine how far along a woman is in her pregnancy. Most states prohibit abortions after a certain point. Just last year, five states — Alabama, Idaho, Indiana, Kansas, and Oklahoma - joined Nebraska in banning abortion at or beyond 20 weeks' gestation.
Fewer than a dozen states have ultrasound laws, but they vary, according to the Guttmacher Institute. Indiana and Iowa, for example, require abortion providers offer an ultrasound, but do not make it mandatory. Arizona, Florida and Kansas do require ultrasounds, but abortion providers must only offer women the opportunity to see the image or listen to a description of the image, according to Guttmacher.
In Texas, the abortion provider must turn the monitor screen so that the woman can see the image (the woman can turn her head or close or eyes if she wants) and the provider must make the fetal heartbeat audible for the woman and explain what the woman is hearing.
Opponents say the ultrasounds are medically unnecessary, intrusive and insulting to women. Charniele Herring, Minority Whip of the Virginia House of Delegates, likened the trans-vaginal ultrasound to "state-sponsored rape."
Anti-abortion groups say the ultrasound images can lead to a more informed decision and argue that vaginal ultrasounds are routinely used. Mary Spaulding Balch, director of state legislation for the National Right to Life Committee , supported the measure in an editorial in USA Today, while editorials opposing the effort appeared in USA Today and The New York Times.
Guttmacher's Nash is concerned that the revised Virginia law will be viewed as a moderate compromise, when she says it's not. These ultrasounds aren't needed for the women's health and add an unnecessary cost, she says. Since most women pay for abortions out of pocket, the ultrasound would add about $150 to the estimated $470 that an abortion can cost.
Americans United for Life called the Virginia law "the gold standard of medical care."
What happened in Virginia may be influencing debates in other states. In Alabama, State Senator Clay Scofield chose not to go with his original legislation that would have required women seeking an abortion to submit to an ultrasound that would provide a clear image of the fetus and instead plans legislation that would give women a choice in the procedure, reports The Montgomery Advertiser .
In Oklahoma, the state Senate approved a bill that would require doctors tell women they have the right to hear the heartbeat of the fetus before an abortion. The original version would have required a woman to hear the fetal heartbeat, Reuters reported .
Among other states looking this year to amend existing ultrasound laws or enact new measures are Arizona, Florida, Idaho, Kansas, Louisiana, Mississippi and Pennsylvania.