## Facts

- Pregnant women seeking abortions, abortion providers, and clinics brought a class action for declaratory and permanent injunctive relief challenging multiple Louisiana abortion regulations enforced by state officials.
- One challenged provision required an attending physician to perform an ultrasound before an abortion.
- Plaintiffs presented evidence that the ultrasound mandate would add at least $100 to the cost of an abortion, at a time when typical abortion costs ranged roughly from $60 to $195.
- Plaintiffs showed that few abortion providers had ultrasound equipment or training, and that ultrasound time demands would reduce the number of abortions that could be performed in a four-hour period from 24 to 8.
- The State asserted the ultrasound requirement improved medical decisionmaking by determining gestational age and the appropriate abortion method.
- Physician testimony indicated clinical examination and ultrasound were comparably accurate methods for determining gestational age, and the State did not show clinical methods were unreliable.
- Plaintiffs also challenged state-mandated information requirements and provisions regulating fetal-remains disposition and restricting experimentation, arguing they deterred access and exposed providers to criminal penalties.

## Issues

1. Whether the mandatory ultrasound requirement and other challenged provisions imposed a direct burden on the constitutional right to choose abortion.
2. If a provision directly burdened abortion access, whether the State proved a compelling interest and sufficient tailoring to justify the burden.
3. Whether certain fetal-remains and experimentation restrictions were invalid for vagueness under due process.

## Decision

- The court held the mandatory pre-abortion ultrasound requirement unconstitutional and permanently enjoined its enforcement.
- The court declared unconstitutional and enjoined enforcement of certain challenged information and fetal-remains-related provisions.
- The court upheld other portions of the statutory scheme that it found did not directly burden the abortion decision or were otherwise consistent with governing precedent.

## Legal Principles

- Regulations that directly interfere with access to abortion—such as government-imposed requirements that materially increase cost or reduce availability—are treated as direct burdens and are subject to strict scrutiny.
- The State’s refusal to subsidize abortion differs from affirmative regulations that create obstacles to obtaining abortion services; the latter may trigger heightened constitutional review.
- Under strict scrutiny, the State must prove a compelling interest and justify the challenged requirement as necessary rather than speculative or unsupported by evidence.
- Medical-necessity rationales fail where the State does not show the mandated procedure is meaningfully superior to accepted alternatives.
- Statutory restrictions enforced through criminal penalties may be invalid if unconstitutionally vague.

## Conclusion

The court applied strict scrutiny to Louisiana provisions that functioned as state-created obstacles to abortion access, invalidating the mandatory ultrasound requirement and striking additional provisions that imposed unjustified burdens or lacked constitutionally sufficient clarity, while leaving in place portions not found to directly burden the abortion right.


Margaret S. v. Treen, 597 F. Supp. 636 (E.D. La. 1984)