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State Laws

North Carolina


Political Information

Executive (Governor)

Pro-choice

Senate

Mixed-choice

House

Mixed-choice

Abortion-Care Policies

Abortion Providers

Abortion Providers: Restrictions

North Carolina imposes extra restrictions on abortion providers, despite the fact that all health-care providers already must comply with a variety of federal and state regulations governing health, safety, building and fire codes, and zoning requirements.

Restrictions on Where Abortion Services May Be Provided

Among the most common TRAP regulations are those restricting the provision of abortion services to hospitals or other specialized facilities, which place medically unnecessary and costly requirements on doctors and can decrease the availability of abortion care for women.  North Carolina has such regulations, including:

Any non-hospital provider that provides abortion services during the first 20 weeks of pregnancy must be "certified" as an abortion clinic and must comply with a uniquely imposed licensure scheme not required of other medical providers. N.C. Gen. Stat. Ann. § 14-45.1(a) (Enacted 1967; Last Amended 1997); N.C. Admin. Code tit. 10A, r. 14E.0101(1).

A clinic must hire a registered nurse with experience in "post-operative or post-partum care" to be on duty in the clinic at all times when patients are in the facility.  N.C. Admin. Code tit. 10A, r. 14E.0307. Exceptions are not provided for times when nursing services are not being performed, or when physicians and/or other medical personnel are present.

A clinic must include at least 18 individual physical components, including its own laboratory and a "nourishment station" for "serving meals or in-between meal snacks."  N.C. Admin. Code tit. 10A, r. 14E.0207. The air temperature must be maintained between 75 and 80 degrees in patient recovery rooms and between 70 and 76 degrees in procedure rooms with humidity between 50 and 60 percent, and the ventilation system must change air flow six time an hour for certain rooms in the facility and 10 times per hour for others.  N.C. Admin. Code tit. 10A, r. 14E.0206.

  

The state health department has the authority and latitude-through regulatory means-to require any abortion facility to comply with the requirements for licensure of ambulatory surgical centers, or mini-hospitals. N.C. Gen. Stat. Ann. § 14-45.1 (Enacted 1967; Last Amended 2013), S. 353, 2013 Gen. Assem., Reg. Sess. (N.C. 2013).

North Carolina requires that all abortion services after the 20th week be provided in a licensed hospital. N.C. Gen. Stat. Ann. § 14-45.1(b) (Enacted 1967; Last Amended 1997).  Such a requirement is unconstitutional and unenforceable under a U.S. Supreme Court case, which held that such a requirement unconstitutionally burdens a woman’s right to choose. Akron v. Akron Ctr. for Reprod. Health 462 U.S. 416 (1983).

All North Carolina clinics are subject to annual inspection by the state Department of Health and Human Services, and the state is required to publish the results of the inspections on a state webpage. Additionally, physicians who provide abortion care to a woman after 16 weeks must convey numerous statistics to the Department of Health and Human Services, including an ultrasound image. N.C. Gen. Stat. Ann. §§ 14-45.1 (Enacted 1967; Last Amended 2015), H.B.465, 152nd Leg., (N.C. 2015).

Restrictions on Who May Provide Abortion Services

North Carolina prohibits certain qualified health-care professionals from providing abortion services.

Only a physician who is licensed to practice medicine in the state, possesses or is eligible to possess board certification in obstetrics or gynecology, or possesses sufficient training based on established medical standards in safe abortion care, abortion complications, and miscarriage management may provide abortion care. N.C. Gen. Stat. Ann. §§ 14-45.1(a) – (b) (Enacted 1967; Last Amended 2015).


Abortion Rights

Post-Viability Ban

North Carolina’s post-viability abortion restriction states that no abortion may be provided after 20 weeks of pregnancy unless there is a "substantial risk" that continuance of the pregnancy would threaten the woman’s life or "gravely impair" her health.  N.C. Gen. Stat. Ann. § 14-45.1(b) (Enacted 1967; Last Amended 1997).

NARAL Pro-Choice America supports the legal framework established in Roe v. Wade and does not oppose restrictions on post-viability abortion so long as they contain adequate exceptions to protect the woman’s life and health.  NARAL Pro-Choice America opposes North Carolina’s post-viability restriction because the health exception is dangerously narrow.  NARAL Pro-Choice America further opposes this law because it is unconstitutional to the extent that it prohibits pre-viability abortion by defining viability at 20 weeks.  A state may not prohibit abortion prior to viability, which is that point at which a fetus is capable of "meaningful life" outside a woman’s body.  Roe v. Wade, 410 U.S. 113, 163 (1973).  Because viability is a point that varies with each pregnancy, states may not declare that it occurs at a particular gestational age.  Colautti v. Franklin, 439 U.S. 379, 388-89 (1979).  


Reasons-Based Ban: Race- and/or Sex Selection

North Carolina bans abortion if the provider has knowledge or an objective reason to know that a significant factor in the woman’s reason for getting an abortion is the sex of the pregnancy. The law includes a right of action for the woman, the spouse or guardian of the woman, or her parent if she is a minor. §§ N.C. Gen. Stat. Ann. 90-21.120 to 123, S.B.353, Reg. Sess. (N.C. 2013).


Abortion Bans Throughout Pregnancy: Ban by Week

North Carolina’s post-viability abortion restriction states that no abortion may be provided after 20 weeks of pregnancy unless there is a "substantial risk" that continuance of the pregnancy would threaten the woman’s life or "gravely impair" her health.  N.C. Gen. Stat. Ann. § 14-45.1(b) (Enacted 1967; Last Amended 1997). The law was amended to narrow that exception to cases of medical emergency. N.C. Gen. Stat. §§ 14-44, 14-45, 14-45.1 (Enacted 2016). Litigators have brought suit on the grounds that the law criminalizes previability abortion. Bryant v. Woodall,


Biased Counseling

Biased Counseling

Except in the case of a medical emergency, a woman may not obtain abortion services until at least 72 hours after the physician or qualified professional tells her by phone or in person: (1) the name of the physician who will provide abortion care; (2) the medical risks associated with abortion care; (3) the probable gestational age of the "unborn child"; (4) the medical risks associated with carrying the pregnancy to term; (5) the attending or referring physician must provide an ultrasound prior to the abortion and that the woman has the right to view the ultrasound prior to the abortion; (6) if the physician who is to provide abortion care does not have liability insurance for malpractice reasons; and (7) the location of a hospital within 30 miles that provides obstetrical or gynecological care.

Additionally, 24 hours before receiving abortion services, the physician or qualified professional must tell the woman by phone or in person: (1) that medical assistance from federal and/or state programs may be available for prenatal care; (2) the father is liable to assist in support for the child; (3) that there are alternatives to abortion; and (4) that she is free to withhold or withdraw her consent at any time without impacting her availability for state or federal assistance programs.

The state Department of Health and Human Services must publish printed materials and make them available online.  The printed materials must: (1) provide geographically indexed materials designed to inform a woman of public and private agencies and services available to assist her through her pregnancy, including adoption agencies; and (2) inform the woman of the probable anatomical and physiological characteristics of the "unborn child" at two-week gestational increments from the time a woman can be known to be pregnant until full term.  The materials shall contain objective information describing the abortion care , the medical risks associated with it, the possible adverse psychological effects of abortion, and the medical risks associated with carrying an unborn child to term.

In addition, prior to an abortion, the woman must be offered the opportunity to review a state-prepared videotape that must include much of the information provided in the state-prepared materials. N.C. Gen. Stat. Ann. § 90-21.80-92 (Enacted 2011); § 90-21.82 (Amended 2015).


Mandatory Delays

Mandatory Delay

North Carolina requires a woman seeking an abortion to wait at least 72 hours between the time she receives biased-counseling materials and when she can get the procedure. N.C. Gen. Stat. Ann. § 90-21.80-92 (Enacted 2011); § 90-21.82 (Amended 2015) .


Insurance Coverage & Abortion

Prohibits Abortion Coverage in the Insurance Exchange

Does North Carolina expressly prohibit plans in its state exchange from covering abortion services?

Yes.  Health-insurance policies offered in the state health-insurance exchange may not include abortion coverage, with exceptions only to save a woman’s life, or if the pregnancy is the result of rape or incest.  Nothing in the law prohibits the purchase of abortion coverage outside the exchange through an optional rider for which an additional premium is paid.  However, insurers are not required to offer such riders and there is no evidence that such separate policies exist. (Even if they did exist, offering women the "option" to pay for separate abortion coverage is a false promise because no one plans for an unplanned pregnancy.)  N.C. Gen. Stat. Ann. §§ 58-51-63 (Enacted 2013).


Prohibits Abortion Coverage for Public Employees

Does North Carolina expressly prohibit insurance plans for public employees from covering abortion services?

Yes.  State funds may not be used to pay for the administration of any governmental health plans or government-offered insurance policy provided to state, county, or city employees that include abortion coverage, with exceptions only to save a woman’s life, or if the pregnancy is the result of rape or incest.  Nothing in the law prohibits the purchase of abortion coverage outside the exchange through an optional rider for which an additional premium is paid.  However, insurers are not required to offer such riders and there is no evidence that such separate policies exist. (Even if they did exist, offering women the "option" to pay for separate abortion coverage is a false promise because no one plans for an unplanned pregnancy.)  N.C. Gen. Stat. Ann. §§ 143C-6-5.5 (Enacted 2011).


Supports Insurance Coverage of Contraception

North Carolina law requires health-insurance plans that cover prescription medication to provide equitable coverage for contraception.

What is required?  If a health-insurance plan provides coverage for prescription medication, devices or outpatient services, it must provide coverage for Food and Drug Administration-approved prescription contraception, except for the emergency contraceptive Preven or any equivalent product.

To which insurance plans does the law apply?  Insurers providing health-benefit plans that are issued or delivered on or after January 1, 2000 that provide coverage for prescription medication, devices or outpatient services.

Does the law provide additional protections for women?  Yes.  Such plans may not impose different deductibles, coinsurance, or limitations for contraceptive medication, devices, or services from those imposed on other medications, devices, or outpatient services.  In addition, plans may not:  (1) deny eligibility solely for the purpose of avoiding the contraceptive-coverage requirement; (2) provide monetary payments to encourage an insured to accept less than the minimum coverage required by this section; (3) penalize or otherwise limit the reimbursement of a provider because he or she provided contraception; or (4) provide incentives to encourage providers to withhold contraception.

Does the law contain a refusal clause, allowing certain employers and/or insurers to refuse to provide or pay for contraceptive coverage?  Yes.

To whom does the refusal clause apply?  Religious employers for whom prescription contraceptive drugs or devices are contrary to their religious tenets.

What does the refusal clause allow?  A religious employer may require issuers of its health-insurance plans to exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? No. The law carefully defines the term "religious employer" as a tax-exempt entity that is organized and operated for religious purposes, has a primary purpose of inculcating religious values, and primarily employs persons who share the religious tenets of the entity.  This definition appropriately covers religious entities but not broad-based entities that operate in the public sphere.

Does the law require that the persons affected by the refusal be notified?  Yes.  An insurer providing health-benefit plans to a religious employer exercising a religious refusal must provide written notice of the exclusion to each insured.  The notice must appear in the plan, application, and sales brochure for the plan.

Are there circumstances under which a refusal clause may not be exercised?  Yes.  A refusal clause may not be used to exclude coverage for prescription medication ordered for reasons other than contraception or for prescription contraception that is necessary to preserve the life or health of an insured.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause?  No.

N.C. Gen. Stat. Ann. §§ 58-3-178, (Enacted 1999).


Low-Income Women & Abortion

Restricts Low-Income Women’s Access to Abortion

North Carolina prohibits funding for abortion for women eligible for state medical assistance for general health care unless the procedure is necessary to preserve the life of a woman endangered by a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, or the pregnancy is the result of rape or incest.  Dep’t of Health & Human Servs., Div. of Med. Assistance, Therapeutic and Non-therapeutic Abortions Policy, (May 2007), at http://www.dhhs.state.nc.us/dma/mp/1E2.pdf.

A woman who is not eligible for Medicaid and whose income is below the federal poverty level may obtain funds from the North Carolina State Abortion Fund to pay for an abortion only if the procedure is necessary to preserve her life or the pregnancy is the result of rape or incest.  H.B. 397, 2003 Gen. Assem., 1st Sess. (N.C. 2003).  A court held that this restriction is constitutional under the North Carolina Constitution.  Rosie J. v. N.C. Dep’t of Human Res., 491 S.E.2d 535 (N.C. 1997).


Young Women & Abortion

Parental Consent

North Carolina law restricts young women’s access to abortion.

Is the law enforceable?  Yes.  A federal court held that this law is constitutional.  Manning v. Hunt, 119 F.3d 254 (4th Cir. 1997).

Who is considered a minor?  A young woman under the age of 18 who has never been married or emancipated.

What is required – parental consent or parental notice?  Consent.

Who must provide consent?  One parent.

Are there other trusted adults who may provide consent instead?  Yes, a grandparent with whom the young woman has been living for six months.

What is the process for obtaining consent?  A young woman may not obtain an abortion unless the attending physician or another physician secures written consent from one parent or a grandparent.

May the parental mandate be waived if a young woman is a victim of rape or incest?  No, unless a court finds that the young woman is a victim of rape or "felonious incest."

May the parental mandate be waived if a young woman is a victim of child abuse?  No.

May the parental mandate be waived if a young woman’s health is threatened?  Yes, but only if the attending physician determines that a "medical emergency exists that so complicates the pregnancy as to require an immediate abortion."

May the parental mandate be waived under any other circumstances?  Yes, the young woman may try to obtain permission from a judge.

If a young woman must obtain permission from a judge, what is the process?  She must secure a court order stating that she is mature and well informed enough to make her own decision, that parental consent is not in her best interests, or that she is a victim of rape or "felonious incest."

Are there other significant requirements under the law?  No.

Has a court considered the constitutionality of this law?  Yes.  A court denied a motion seeking a preliminary injunction of this law.  Manning v. Hunt, 119 F.3d 254 (4th Cir. 1997).

Other information about the law:  None.

N.C. Gen. Stat. Ann. §§ 90-21.6 (Enacted 1995; Last Amended 1998), 90-21.7, .9, .10 (Enacted 1995), 90-21.8 (Enacted 1995; Last Amended 2000).


Family-Planning Policies

Insurance Coverage & Contraception

No state measure.

Low-Income Women & Contraception

Supports Low-Income Women’s Access to Contraception

North Carolina provides increased access to reproductive-health-care services through a State Plan Amendment (SPA) to its Medicaid program. The SPA allows the state to cover family-planning services for women and men with family incomes at or below 200 percent of the federal poverty level who are not currently enrolled in Medicaid and do not have any other health insurance.  Additionally, enrollees must be (1) U.S. citizens or persons who meet the state’s defined immigration requirements and (2) North Carolina residents.

Beneficiaries of family-planning coverage through the SPA are not required to pay premiums or co-payments for covered services.  Covered services include: family-planning visits; pregnancy examination and testing; contraceptive management, including but not limited to fertility awareness and natural family planning; medication and supplies for the purpose of temporary pregnancy prevention; injection, fitting, insertion, and removal of contraceptive devices; affiliated laboratory tests; and sterilization.

North Carolina Medicaid State Plan Amendment, NC-14-0005-MM1, at http://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/NC/NC-14-0005-MM1.pdf;  

North Carolina Medicaid State Plan Amendment, NC 11-040, at http://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/NC/NC-11-040-Ltr.pdf;  

North Carolina Be Smart Fact Sheet, at http://www2.ncdhhs.gov/dma/medicaid/familyplanning.htm.


Emergency Contraception

No state measure.

Other Important Issues

Clinic Protections

Clinic Protections

Any person participating in, affiliated with, or present as a spectator at a demonstration upon a private health-care facility or upon any public place and willfully or intentionally possessing or having immediate access to any dangerous weapon is guilty of a misdemeanor. N.C. Gen. Stat. Ann. §14-277.2 (Enacted 1981; Last Amended 1994). Any person who obstructs another person’s access to or egress from a health-care facility in a manner that deprives or delays the person from obtaining or providing health-care services, or who injures or threatens another person who is providing, obtaining, or aiding another to obtain health-care services, is guilty of a misdemeanor. A third or subsequent conviction within three years of a prior conviction is punishable as a felony. Any person aggrieved may seek injunctive relief. A violation of an injunction obtained pursuant to this section constitutes criminal contempt punishable by imprisonment for 30 days to 12 months. N.C. Gen. Stat. Ann. §14-277.4 (Enacted 1993; Last Amended 1994). A court held that this law is constitutional. Hoffman v. Hunt, 126 F.3d 575 (4th Cir. 1997), cert. denied, 523 U.S. 1136 (1998).  Any person engaging in targeted picketing of another individual’s residence that causes fear for that individual’s safety, the safety of the individual’s family or personal associates, or creates substantial emotional distress is guilty of a misdemeanor.  N.C. Gen. Stat. Ann. §14-277.4A (Enacted 2009).


Fake Health Centers

State Funds Crisis Pregnancy Centers

North Carolina funds fake health centers directly through taxpayer funds. The funding stream is established through the "Carolina Pregnancy Care Fellowship," administered by the Department of Health and Human Services.  Fake health centers are eligible to receive $1,300,000 in FY’17-18 and $1,000,000 in FY’18-19 through this funding stream.  The Fellowship receives $440,000 per fiscal year through Maternal and Child Health Block Grants. S.B. No. 99, Gen. Assem., Reg. Sess. (N.C. 2018).


State Refers to Crisis Pregnancy Centers

North Carolina law refers women to crisis pregnancy centers (CPCs). In connection with the state’s biased-counseling and mandatory-delay law, when a woman tells a health-care provider she is considering abortion, the provider must give her a state-maintained list of facilities that will satisfy the law’s mandate. CPCs are included on the list without disclaimer of their biased nature and are not distinguished from legitimate health centers.  N.C. Gen. Stat. Ann. § 90-21.83 (Enacted, 2011; Last Amended, 2013).


State has Anti-Choice License Plates

North Carolina law provides for a "Choose Life" license-plate program that funnels money to anti-choice organizations. The program is operated by the state Division of Motor Vehicles and drivers are able to purchase the specialty license plate for a fee. A percentage of the fee is retained by the state to recoup administrative costs; the rest of the funds are directed to the Carolina Pregnancy Care Fellowship.  N.C. Stat. Ann. §§ 20-79.4 (2013), 20-81.12 (Enacted, 1991; Last Amended, 2013).

In 2014, the Fourth Circuit Court of Appeals ruled that North Carolina’s law establishing a "Choose Life" license-plate program was unconstitutional and unenforceable.  The court found that license plates are private speech so a law in which the government favors one position "constitutes blatant viewpoint discrimination squarely at odds with the First Amendment." American Civil Liberties Union of North Carolina v. Tata, 742 F.3d 563 (4th Cir. 2014).

Subsequently, North Carolina state legislators requested and were given permission to become additional defendants in the case; they petitioned the U.S. Supreme Court to take up the case.  In July 2015, the Supreme Court vacated the circuit court’s decision and remanded the case back to the circuit court for further consideration, based on the high court’s decision in a related case about Confederate flag plates in Texas.  In that case, the Supreme Court found that license plates are government speech, not private speech, so states may in fact favor one position.  Berger, et al., v. American Civil Liberties Union of North Carolina, 14-35, Order List U.S.576 (2015).

In March 2016, the Fourth Circuit Court of Appeals reconsidered the case in light of the Supreme Court’s decision.  The circuit court reversed its previous ruling and remanded the case to the district court with instructions to rule in favor of the state.  The court ruled that North Carolina’s "Choose Life" license-plate program is government speech, thus the state is free to accept license-plate designs conveying messages with which it agrees and reject those with which it disagrees.  Berger, et al., v. American Civil Liberties Union of North Carolina, 13-1030 (4th Cir. 2016).


Refusals & Guarantees

Refusals of Medical Care

ABORTION REFUSAL CLAUSE

North Carolina allows certain individuals or entities to refuse to provide abortion services.

To whom does the refusal clause apply? Physicians, nurses, health-care providers, hospitals, and other health-care institutions.

What does the refusal clause allow? Allows physicians licensed to practice medicine in the state, nurses, and other health-care providers who objects on moral, ethical, or religious grounds to refuse to participate in medical procedures that result in an abortion. The refusal to participate may not be a basis for civil liability, disciplinary action, or other recriminatory action. Allows hospitals, health-care institutions, and health-care providers to refuse to provide abortion services.

Does the law require the refusing entity to notify the persons affected? No.

Are there circumstances under which a refusal clause may not be exercised? No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services? No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause? No.

N.C. Gen. Stat. Ann. §§ 14-45.1(e), (f) (Enacted 1967; Last Amended 2013).

INSURANCE COVERAGE FOR CONTRACEPTION REFUSAL CLAUSE

Although North Carolina law requires health-insurance plans that cover prescription medication to provide equitable coverage for contraception, certain employers may require that their plans exclude coverage for contraception.

To whom does the refusal clause apply? Religious employers for whom prescription contraception is contrary to their religious tenets.

What does the refusal clause allow? A religious employer may require issuers of its health-insurance plans to exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? Yes.  The law broadly defines the term "religious employer" as a non-profit organization that has as one of its primary purposes the inculcation of religious values and primarily employs persons who share its religious tenets.  This exemption allows a broad range of organizations engaged in secular activities and operating in the public sphere to deny women insurance coverage for contraception.

Does the law require that the persons affected by the refusal be notified? Yes. An insurer providing health-benefit plans to a religious employer exercising a religious refusal must provide written notice of the exclusion to each insured. The notice must appear in the plan, application, and sales brochure for the plan.

Are there circumstances under which a refusal clause may not be exercised? Yes. A refusal clause may not be used to exclude coverage for prescription medication ordered for reasons other than contraception or for prescription contraception that is necessary to preserve the life or health of an insured person.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause? No.

N.C. Gen. Stat. Ann. §§ 58-3-178, 58-50-155 (Enacted 1999).

PHARMACIST REFUSAL CLAUSE

North Carolina allows pharmacists to refuse to fill or refill prescriptions.

To whom does the refusal clause apply? Pharmacists.

What does the refusal clause allow? Pharmacists or dispensers of devices and medical equipment may refuse to fill or refill a prescription order if, in the pharmacist’s professional judgment, it would be harmful to the recipient, is not in the recipient’s best interest, or if there is a question as to its validity.

Does the law require the refusing entity to notify the persons affected? No.

Are there circumstances under which a refusal clause may not be exercised? No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for prescription services? No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause? No.

N.C. Admin. Code. tit 21, § 46.1801 (Enacted 1983, Amended 2007).


Counseling & Referral Bans

No state measure.

Everyone should be able to decide if, when, how, and with whom they start or grow a family.

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