This report presents findings from a qualitative study examining policies in North Carolina that may further restrict abortion access beyond the state's current gestational limit of 12 weeks and 6 days. Specifically, the authors detail current laws and policies, how these policies are implemented [JR1] across different facility types, and the reported impact of these policies on abortion care delivery and access in North Carolina.

Understanding the State and Local Policies Affecting Abortion Care Administration, Access, and Delivery

A Case Study in North Carolina

Julia Rollison, Skye A. Miner, Maya Buenaventura, Maya Rabinowitz

ResearchPublished Jun 20, 2024

The implementation and enforcement of state and local abortion policy can vary significantly between medical clinics and depend on the context and the individual decisionmakers involved. Research conducted prior to the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization showed that, when providers are unclear about potentially conflicting or changing local and state policies (formal and informal) or enforcement, many err on the side of caution and become more restrictive in their practices. However, it is unknown whether and to what extent state and local policies and practices adapted in the wake of Dobbs have influenced providers' practices.

The authors conducted an initial study of laws and policies post-Dobbs in one state, North Carolina, to better understand the policy landscape and gather perspectives from staff in facilities or organizations that provide or support abortion care. This study served as a unique opportunity to explore laws and policies, as well as implementation experiences, given North Carolina's Senate Bill 20, which instituted a gestational limit of 12 weeks and 6 days, as well as other provisions, including a 72-hour in-person consent requirement. The findings highlight the reported impacts of Senate Bill 20 on facilities, providers, and patients, as well as other local and institutional policies on abortion care access. This work highlights the importance of understanding legislation and its underlying provisions to ensure a complete picture of implementation factors and potential impacts.

Key Findings

  • Of the provisions in Senate Bill 20, the reduced gestational limit and the 72-hour in-person consent requirement were the most-restrictive components.
  • Local laws did not play a large role in abortion provision, although noise ordinances influenced access at clinics with protesters.
  • Individual facilities adapted policies and workflows to align with their organizations' interpretations of Senate Bill 20 and its provisions, such as stipulating that two providers must agree on medical exceptions or implementing a referral system for people who are 12 weeks and 3 days pregnant or later at the time of their ultrasounds because of the 72-hour in-person consent requirement.
  • Facilities reported reorganizing or changing clinical workflows, adjusting staffing, facing increased costs, losing patients, and physically relocating some clinics to adapt to Senate Bill 20 provisions.
  • Providers reported increased time on administrative tasks, frustration with required consent forms, feelings of anxiety and burnout, and fears for the future pipeline of providers in the state.
  • Providers reported that patients faced increased resource and time burdens, particularly with the in-person consent requirement, with a disproportionate impact for more historically marginalized populations.
  • Providers reported that individuals seeking care faced limitations on decisionmaking inputs, combined with high levels of confusion and misinformation.

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Rollison, Julia, Skye A. Miner, Maya Buenaventura, and Maya Rabinowitz, Understanding the State and Local Policies Affecting Abortion Care Administration, Access, and Delivery: A Case Study in North Carolina. Santa Monica, CA: RAND Corporation, 2024. https://www.rand.org/pubs/research_reports/RRA3324-1.html.
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This research was sponsored by Dana Guerin and conducted in the Social and Behavioral Policy Program within RAND Social and Economic Well-Being.

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