This is the third part of NUVO's coverage of HEA 1337.
HEA 1337 is law in Indiana effective July 1. The wide-sweeping bill has been called the strictest abortion law in the nation.
The bill outlaws abortion entirely for a variety of reasons, adds additional barriers to access, and requires each aborted or miscarried fetus be buried or cremated.
Our editorial stance is that HEA 1337 does not protect the interests of pro-choice or anti-choice women. Simply put, HEA 1337 makes Indiana the most hostile state for women’s rights in the nation.
We examined the impact of HEA 1337 on Hoosier women from a variety of angles. Other the next days, we'll examine the impact of the new law and publish women's stories of abortion and miscarriage.
Planned Parenthood's response
When it comes to abortion providers one organization instantly comes to mind: Planned Parenthood. The national organization specializes in reproductive care and education for women, men and teens. As a part of its reproductive care for women Planned Parenthood does provide abortion services for women who want the procedure as an option.
HEA 1337 creates a long list of new provisions Planned Parenthood is tasked with implementing.
“We’re taking a look at them right now to work through those provisions and begin to take a look at our processes and make sure that we’re modifying the way that we do things to be in compliance with the law,” says Patti Stauffer, vice president of public policy, strategy and compliance for Planned Parenthood of Indiana and Kentucky.
Stauffer’s job is to make sure that Planned Parenthood branches are in compliance with the law. And HEA 1337 is full of challenges.
“We’re also waiting [for] additional guidance from the State Department of Health, which is the licensing entity for our abortion facilities,” says Stauffer. “There is a lot of really vague language in the bill that is making it difficult for us to understand what compliance would look like.”
Understanding the requirements for final disposition of fetal remains is proving to be one of the biggest challenges Planned Parenthood is facing in meeting that compliance. The legislation requires fetal remains to be treated as human remains and not biomedical waste. In other words, instead of disposing aborted or miscarried remains the same as a uterus removed in a hysterectomy or a damaged kidney removed in a transplant, fetal remains must now be buried or cremated.
Law dictates the final disposition of human remains. Funeral directors in the state are licensed to adhere to a strict process dictated by public policy. The journey of a body from its location of death to final disposition is detailed and documented from start to finish.
“I have reached out to the funeral home association [and] I’ve reached out to the coroners association asking them if they would take a look at this and try to offer some input or guidance as to how this could all be interpreted,” says Stauffer. “I haven’t gotten clear direction and we’re hoping that the State Department of Health will be able to help us with some of this because it is all very complicated and pretty confusing.”
Stauffer says Planned Parenthood is trying to develop and establish new relationships with funeral homes to partner with for final disposition arrangements but have yet to solidify a partnership.
NUVO reached out to some funeral homes in Indianapolis to discuss some of the details, but none were willing to talk about HEA 1337, and all said they would not be partnering with the abortion provider.
Another problem created by the final disposition clause is the potential revelation of a woman’s identity. HEA 1337 has language designed to protect identities through redaction, but Stauffer says that isn’t guaranteed because of the numerous amounts of documentation involved.
“One is the burial transit permit. And there are several fields on that form — next of kin as an example, also dates, facility,” says Stauffer. “So if you start connecting all of those dots that this next of kin on this date was at Planned Parenthood, that’s very dangerous information and it wouldn’t take much for someone to put two and two together on what that meant.”
There is also the requirement of a death certificate that according to state law is required for a burial transit permit to even be issued. And many of the documents involved are generated and distributed to more than one person or entity.
Other aspects of the bill present concerns for Planned Parenthood. The requirement of an ultrasound and fetal heart tones 18 hours prior to the abortion procedure requires a woman to present herself at least twice. The ban on abortions for reasons of intent — race, color, ancestry, sex, diagnosis or potential diagnosis of the fetus — is also a point of concern.
“We do not traditionally inquire of a woman her motivations and we are extremely concerned about the level of judgment that this kind of language now injects into what is a legal medical procedure,” says Stauffer. “This is a form of governmental intrusion into the privacy of women. It is forcing conversations between physicians and a woman at a time when she should be able to have a very open and honest conversation with her healthcare provider. I think that is very dangerous when you start going down the path of trying to get inside the head of a woman and dictating reasons that may or may not be valid for her to seek what is a legal medical procedure.”
While the new law adds new requirements for a woman seeking an abortion (the 18-hour provision, new forms to fill out, questions to answer, etc.) the weight of responsibility and potential for disciplinary action falls on the doctors and healthcare providers. Stauffer says this is also problematic and puts healthcare providers at risk.
RELATED: Read NUVO's previous coverage of the bill's path through the Statehouse
“They begin to put information and document information onto a public form that is disconnected from the women herself but is certainly leading back to the physician,” says Stauffer. “It is not only shaming women for decisions they feel they need to make for themselves but it is also professionally marginalizing those physicians who have also chosen to offer abortions.”
Indiana law had already required abortion providers to have admitting privileges to a hospital or written agreements with other doctors with admitting privileges. The new law requires written agreements be renewed annually and all lists of providers and doctors with admitting privileges be distributed to all hospitals in the county and contiguous counties.
“There is no reason for admitting privileges to begin with let alone distributing those out and around to all of the hospitals in the county and contiguous counties,” says Stauffer. “All that that seeks to do is to let all of the physicians at all of those other hospitals know, ‘Hey your colleague next door, guess what they’re doing?’”
The motives behind the bill are more transparent than the bill itself. By requiring fetal remains to be treated as human remains in final disposition and banning abortions ostensibly in the name of civil rights indirectly strengthens the anti-choice argument that life begins at conception rather than at a gestational age of viability as the court determined in Roe v. Wade. Making providers liable for statute violations and the increased sharing of providers pressures them to not perform the procedure at all out of self-preservation.
The new restrictions may hamper Planned Parenthood’s operations, but they won’t keep the organization from executing its mission of providing reproductive healthcare and information.
“Indiana has instances of just barreling ahead. We are one of the top four most hostile states for reproductive rights in the country,” says Stauffer. “With this bill we are laying new groundwork and we don’t need to be doing that right now. What we need to be doing is having a really thoughtful conversation about unintended pregnancies and we need strong comprehensive approaches to making sure that we are reducing our unintended pregnancy number which by default would certainly get us to where we want to be in terms of reducing abortions. ... And we need access to birth control and we need access to comprehensive sex education. If we are really serious about this, then let’s do it the right way.”
We collected personal stories from women who chose abortion or experienced miscarriage and asked them how HEA 1337 would have impacted their experience. All stories with names attached are published with explicit permission. We want to thank the women who submitted their stories. In the next few days, we'll publish those stories. If you'd like, you can submit your own at awakeforwomensrights.tumblr.com or email it to NUVO's editors at email@example.com.
This is Naomi Rae Wolsieffer's story.
The third miscarriage of my life has brought me to my knees. I never even got the letter from the hospital about the funeral that was supposed to be held sometime last November. It was the most painful and most gruesome of the three, though none of the miscarriages were pleasant nor easy on my mind, body, or soul.
Since I am leaving my full name, I will leave out the personal details of the emotionally abusive father that I am no longer with. He was with me when it all happened, and at the time was a rock, a man who wanted me to be ok and safe. The biggest and worst part of the day of the miscarriage is this - I didn’t know that the hospital I was having the beginning of the miscarriage in wouldn’t terminate the pregnancy, EVEN THOUGH ITS HEARTBEAT WAS VISIBLY SLOWING DOWN IN FRONT OF THEIR EYES. They SENT ME HOME. Granted, I don’t like hospitals much, but how the hell could they not see that my second trimester pregnancy was NOT GOING TO LIVE?
Hospitals are more often run by religious people who will not terminate possibly harmful pregnancies, because they believe more in miracles than in science. So, instead of being surrounded by doctors and in a safe place, the father and I went back to his house. Within an hour I had a half-formed child in his toilet. He called 911. It was the worst and most unforgettably awful trial that my body has gone through.
This bill would have added SO MUCH MORE stress, pain, and monetary strain. This is an abridged version of an event that has damaged me internally, both physically and emotionally. It’s boggling my freaking mind that the government and super religious Americans still think they can tell me and my fellow ladies what to do with their bodies. HEA 1337 is unconstitutional and simply WRONG.
My heart goes out to other women with similar or completely different stories of pain, loss, and making difficult decisions. Thank you for collecting these stories.