In Texas, women must get a sonogram at least 24 hours before they can get an abortion.

Fewer abortions? Better-informed patients? Insulted women? The impact of a controversial new Texas law that requires women to have a sonogram – and listen to a description of the fetus as well as its heartbeat – at least 24 hours before they can get an abortion is far from clear.

Texas state health officials began enforcing the sonogram provision – which critics say is the most extreme sonogram-related law in the nation – on Tuesday.

Reaction has been decidedly mixed.

Msnbc.com was unable to contact women who have undergone the sonogram this week, but Texas abortion providers say many of their patients felt insulted.

“The emotions range from confusion to anger to being quite emotionally upset by it. Having to hear the position described of fetal development is not something they are wanting to endure,” said Rochelle Tafolla, spokesperson for Planned Parenthood Gulf Coast, which has three centers that provide abortions.

“We haven’t heard of any women who, after going through these steps, are saying, ‘No, I’m changing my mind.’”

The law requires doctors who perform abortions to conduct a sonogram 24 hours before the procedure, display the images of the fetus and make the heartbeat audible. The woman can decline to view the images and listen to the heartbeat. The doctor must also verbally describe the sonogram result – even if the woman doesn’t want to hear it.

Read details of Texas sonogram law

Although the sonogram law technically went into effect last fall, the state didn’t begin enforcing its requirements until Tuesday, when the Texas Department of State Health Services posted guidelines for abortion providers. Facilities that fail to comply face penalties of up to $1,000 per violation per day.

Department spokeswoman Carrie Williams said Wednesday that the state agency has received “a couple of technical questions” about the law’s requirements since its implementation but hasn’t gotten any significant feedback yet from abortion providers or pregnant women.

Effect uncertain at this point

It’s too soon to track the impact of the sonogram law on the number of abortions performed in Texas, which has 39 licensed abortion providers, Williams added.

About 75,000 abortions were performed in Texas in 2010, the latest year for which statistics are available, according to State Health Services.

Elizabeth Graham, director of Texas Right to Life, says anecdotal reports she’s received “from our friends who counsel outside of abortion clinics tell us 70 to 80 percent of women will choose life after seeing a sonogram.”

As for the long-term impact, ”If the clinics are following the law according to its legislative intent, then we think the law could reduce the number of abortions in Texas by at least 30 percent,” she said.

Tafolla said Planned Parenthood Gulf Coast clinics have not seen a drop-off in the number of abortions performed since the sonogram law went into effect Oct. 1.

About 15 percent to 17 percent of pregnant women who undergo the ultrasound at Planned Parenthood don’t come back for the abortion, Tafolla says, but that could be for a number of reasons.

“What we knew by fact is statistically the majority of women who are having abortion are already mothers. They fully understand what a pregnancy is, so they’re making a very informed decision,” she says.

'Most extreme ultrasound-related law'

Julie Rikelman, an attorney with the New York-based Center for Reproductive Rights, which sued unsuccessfully to block the Texas legislation, calls it “the most extreme ultrasound-related law that is being enforced in the United States.”

(Oklahoma and North Carolina have similar laws, but their enforcement has been held up because sonogram requirements were blocked by the courts, Rikelman says.)

“I think the experience of providers has been that women just find it offensive because the presumption of the law is somehow women don’t know what they’re doing and need to be forced to consider information even if it’s not relevant to them. It’s very demeaning to them,” she says.

But Lori DeVillez, executive director of the Austin Pregnancy Resource Center, which provides support services and abortion alternatives to pregnant women, says the sonogram law is “a healthy law.”

Like any other major medical procedure, she says, patients deserve to know beforehand what an abortion entails before they decide whether to undergo it.

Devillez doesn’t know whether the law will eventually lower the number of abortions performed in Texas. But she hopes it does. “I hope giving women the opportunity to get the information they need will help them understand decisions they are making for themselves and their babies,” she says.

Logistical headache for clinics

Perhaps one of the most significant practical impacts of the Texas law to date is logistics, says Amy Hagstrom Miller, founder of Whole Woman’s Health clinics in Texas. The law’s requirements have caused scheduling headaches because doctors who perform abortions now must also perform a sonogram – on a separate day. They can’t delegate that latter task to, say, an ultrasound technician.

And they can’t have another doctor do the abortion if they're busy.

As for patients, many are already mothers and must make separate doctor's visits, often taking an additional day or two off work, Hagstrom Miller said.

“We’ve had a lot of frustration, a lot of, ‘Why do I have to do this? I know what I want to do,’” she said.

The five Whole Woman’s Health clinics began complying with the sonogram law in mid-January. Out of the several hundred women who were offered a chance to listen to the fetal heartbeat, only two opted to do so, Hagstrom Miller says.

Likewise, most women are declining to see their sonogram image, she said.

“I am not aware of anyone saying, ‘Oh my goodness, I didn’t know what the ultrasound looked like and I’m going to change my pregnancy,'” Hagstrom Miller added.

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