A Pennsylvania abortion bill introduced earlier this year has sparked controversy regarding the additional requirement it would place on abortion providers regarding disposition of fetal remains.
Pennsylvania Rep. Frank Ryan (R) introduced a bill () in January that would require abortion providers and facilities to bury and cremate fetal tissue from all abortions and pregnancy losses. The legislation, also known as the Unborn Child Dignity Act, would also effectively mandate the provision of a death certificate for all abortions and pregnancy losses, regardless of gestational age. Currently, death certificates are mandated only for terminations and losses that occur after 16 weeks.
If a parent chooses not to select a location for the remains, responsibility for burying or cremating the fetus will fall on healthcare facilities, the bill says.
Citing the experience of pregnancy loss he experienced in his own family, Ryan said in a that this legislation "creates a stand-alone act which will provide for a respectful internment [sic] of these innocent lives which have been lost."
This year, more states have introduced legislation to require burial or cremation of fetal remains, with states including and already passing similar laws. Indiana's went to the U.S. Supreme Court in 2019, .
While such regulation may not restrict abortion directly, critics say that the burdens it would place on abortion providers, healthcare facilities, and ultimately, patients, could significantly reduce access to care.
"By adopting this kind of restriction, it is making it harder for abortion providers to keep their practices running," said Elizabeth Nash, principal policy associate for state issues at the Guttmacher Institute. Providers may have to work with vendors to cremate or bury fetal remains, which could be challenging as abortion is controversial. "You're adding another burden to the very full plate of requirements they need to comply with," Nash said.
Nash added that she expects more legislation around abortion, especially new mandates for clinics. Regulations on fetal tissue disposal, she said, have been proposed in seven states since the start of this year.
"It's concerning that this could increase the cost to facilities, and therefore to abortion providers," said Daniel Grossman, MD, director of Advancing New Standards in Reproductive Health (ANSRH) at the University of California San Francisco. "Abortion providers already operate on a very narrow margin, and would have to pass on those costs to patients."
Grossman said that the mandate to cremate or bury fetal remains may not seem particularly onerous. "But I think anything that ends up increasing the cost to patients is really quite significant, given the evidence we have that cost is a significant barrier."
Aside from cost increases, Grossman said, requiring a burial or cremation may not entirely respect patient wishes, and could be emotionally taxing for those who lose a pregnancy or choose termination.
Christine Castro, JD, an attorney with the Women's Law Project in Pennsylvania, noted that the need to provide death certificates for earlier-stage abortions and pregnancy losses is not explicitly written in the bill, but rather emerges from other requirements.
"Under Pennsylvania law, a death certificate must be filed in order to arrange for burial or cremation," she explained. Currently, Pennsylvania defines a fetal death as one that takes place after 16 weeks. This legislation, however, does not specify a time marker, broadening it to include abortions and losses at earlier gestational ages.
Castro also pointed out that, since death certificates eventually become public records, this legislation may also violate patient privacy.
As abortion bans -- such as those in Arkansas and South Carolina -- have gained national attention, Nash said it is important to keep in mind how significant these clinic restrictions could be for abortion care access.
"It's not just the abortion bans to pay attention to," Nash said. "It's also the kinds of restrictions that are moving through state legislatures, and how those restrictions work together to make it very difficult for both provision of care, and access to care."