DALLAS — Some pregnant women avert their eyes. Others shed tears or simply tune out the abortion doctors as they describe the fetus and offer them a chance to hear the heartbeat and view the image.
These are the varied reactions seen in clinics across Texas since the state recently began enforcing perhaps the most stringent abortion law in the country. Among other things, the law requires that women seeking abortions hear their doctors describe the fetus' development during a sonogram and then wait 24 hours before undergoing the procedure.
The law has sparked a wave of litigation amid a debate on whether the state is infringing on doctors' rights and making an already stressful decision more traumatic for pregnant women.
"It's condescending," said Dr. Curtis Boyd, medical director and owner of Southwestern Women's Surgery Center in Dallas.
"Before this law was even conceived, women were giving thoughtful consideration to whether they should go through with an unplanned pregnancy."
One 19-year-old woman sitting in Boyd's office on a recent afternoon accepted an offer to hear the heartbeat and see an image of the fetus as the doctor described the developing spine. But for her there was no turning back: With two children already, she said abortion was her best choice.
Another woman waiting for a sonogram in the same clinic didn't express anger or resentment but acknowledged the pregnancy would soon "become a lot more real."
The portion of the law requiring the sonogram and a 24-hour wait went into effect in the fall, but the remaining requirements — describing the fetus and offering patients to see an image and hear the heartbeat — were tied up in litigation until an appeals court ruled last month they could be enforced.
Supporters say the requirements ensure women are making an informed decision before undergoing an abortion, and they predict abortion numbers will drop as a result. Already the state has seen a dramatic decrease over the years: The health department tallied about 75,000 abortions in its latest data from 2010, far fewer than the 92,681 performed in 1990.
"It is something that cannot be taken back, reversed," said Joe Pojman, executive director of Texas Alliance for Life, which supported the new law. He cited testimony last year as the Legislature debated the requirements from women who said they were denied the opportunity to see their sonogram when seeking an abortion.
Clinic administrators say they have seen no difference in the number of women who return after the mandated 24-hour waiting period. They say most of the women show little reaction to the actual sonogram and doctor's description but are upset at having to make multiple appointments.
"We're the first people that educate them about it and so they get really mad at the provider," said Amy Hagstrom Miller, president and chief executive of Whole Woman's Health, which has five clinics across Texas.
"I think women get to this point where it's like, 'What do I need to watch, what do I need to sign, what do I have to say to sign?' Just let me have my procedure.'"
Oklahoma and North Carolina have similar abortion laws, but courts in both states are blocking them. A number of states have other sonogram laws but the vast majority only requires the doctor to offer the woman the chance to view the sonogram, said Julie Rikelman, an attorney for the Center for Reproductive Rights.
The Texas law prompted the New York-based Center for Reproductive Rights to sue on behalf of a group of doctors, arguing it infringed on their First Amendment rights and was unconstitutionally vague regarding enforcement. Earlier this month a federal judge upheld the law but said the appeals court had forced him to declare it constitutional.
Exceptions to the law are made if a patient doesn't live within 100 miles of a provider, if the woman is pregnant as a result of a sexual assault, is underage or has a fetus with an irreversible medical condition or abnormality.
The Texas Department of State Health Services has informed doctors it will check that facilities are meeting the law's requirements during annual inspections and do additional inspections if the department receives complaints. If a doctor violates the law, the Texas Medical Board must refuse to renew that person's license.
Texas already had in place a requirement that a woman take part in a phone call with the provider 24 hours before the abortion so the doctor can tell her certain information mandated by the state. Included in those requirements are that the doctor tells her benefits may be available to help with medical care and that the father is required to help support the child.
Clinic administrators say the new rule, which requires the same doctor who does the sonogram to also perform the abortion, has complicated doctors' and patients' schedules.
Hagstrom Miller said some women have had to schedule their abortion up to two weeks after their initial visit. Other clinics have had to hire a couple more staffers to keep up with the extra appointments.
But these hassles are not the biggest problem Hagstrom Miller has with the law.
"It's about shaming women. It's about delaying abortions. It's about making abortion more difficult to obtain," she said. "But women know exactly what they're making an appointment for."