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Did you know that Maryland was the first state in which cities passed laws requiring fake anti-choice “clinics” to post signs disclosing that they do not provide certain reproductive-health services?

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Current Laws

Maryland is a pro-choice leader
Maryland's strong, pro-choice laws with few restrictions on reproductive rights earned a "B+" in NARAL Pro-Choice America's rating of states' laws.

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Current Laws

Maryland Laws:

Anti Choice Laws:

Physician-Only Restriction:

Only a physician, including a doctor of osteopathy, licensed by the state to practice medicine in the state may perform an abortion. Md. Code Ann., Health-Gen. § 20-207 (Enacted 1970; Last Amended 1982); Md. Code Ann., Health-Gen. § 20-208 (Enacted 1991).

Refusal to Provide Medical Services:

Abortion Refusal Clause

Maryland allows certain individuals or entities to refuse to provide abortion services.

To whom does the refusal clause apply?
Individuals and hospitals.

What does the refusal clause allow?
No person may be required to participate in, or refer to any source for, medical procedures that result in an abortion. No hospital may be required to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in an abortion. The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

A health care provider or hospital is not immune from civil liability or recriminatory action if the refusal to refer caused death or serious physical or long-lasting injury to the woman and was otherwise contrary to the standards of medical care.

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.

Has a court considered the constitutionality of this law?
A court has interpreted this law's use of "refer" to apply only to the refusal to refer patients and not to protect a hospital's refusal to send residents outside of the hospital to gain clinical experience in abortion services. St. Agnes Hosp. of Baltimore, Inc. v. Riddick, 748 F. Supp. 319 (D. Md. 1990).

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1973; Last Amended 1991).

Contraceptive Equity Refusal Clause

Although Maryland law requires health insurance plans that cover prescription drugs to provide equitable coverage for contraception, certain employers and/or insurers may require that their plans exclude coverage for contraception.

To whom does the refusal clause apply?
Religious employers for whom contraceptive coverage conflicts with their bona fide religious beliefs and practices.

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

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?
Yes. By failing to define the term "religious employer," the law's refusal clause inappropriately includes a wide range of entities that perform non-religious functions in the public sphere.

Does the law require the refusing entity to notify the persons affected?
Yes. An employer exercising a refusal clause must provide employees reasonable and timely notice of the exclusion.

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

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

MD. Code Ann., Ins. § 15-826 (Enacted 1998).

Sterilization Refusal Clause

Maryland allows certain individuals or entities to refuse to perform or participate in sterilizing procedures.

To whom does the refusal clause apply?
Individuals and hospitals.

What does the refusal clause allow?
No person may be required to participate in, or refer to any source for, medical procedures that result in sterilization. No hospital may be required to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in sterilization. The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

A health care provider or hospital is not immune from civil liability or recriminatory action if the refusal to refer caused death or serious physical or long-lasting injury to the woman and was otherwise contrary to the standards of medical care.

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.

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1973; Last Amended 1991).

Artificial Insemination Refusal Clause

Maryland allows certain individuals or entities to refuse to perform or participate in artificial insemination procedures.

To whom does the refusal clause apply?
Individuals and hospitals.

What does the refusal clause allow?
No person may be required to participate in, or refer to any source for, medical procedures that result in artificial insemination. No hospital may be required to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in artificial insemination. The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

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.

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1973; Last Amended 1991).

Restriction on Young Women's Access to Abortion

Maryland law restricts young women's access to abortion.

Is the law enforceable?
Yes.

Who is considered a minor?
A young woman under the age of 18.

What is required - parental consent or notice?
Notice.

Who must be notified?
One parent.

Are there other trusted adults who may be notified instead?
No.

What is the process for obtaining notification?
A young woman may not obtain an abortion unless the attending physician gives notice to a parent, unless the young woman does not live with a parent and a reasonable, but unsuccessful effort has been made to give notice to a parent. A postal receipt showing that mail was sent by certified mail to the last known address of a parent is conclusive evidence of notice or a reasonable effort to give notice.

May the parental mandate be waived if a young woman is a victim of rape or incest?
No.

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. A physician has discretion to perform an abortion for a minor when, "in the professional judgment of the physician," parental "[n]otification would not be in the best interest of the minor."

May the parental mandate be waived under any other circumstances?
Yes. There are three situations in which a physician has discretion to perform an abortion for a minor without parental notification. The physician would make the professional judgment that either: (1) notice to the parent may lead to physical or emotional abuse of the minor; (2) the young woman is mature and capable of giving informed consent to an abortion; or (3) notice would not be in the best interest of the young woman.

Are there other significant requirements under the law?
No. The law does not contain a judicial bypass procedure.

Has a court considered the constitutionality of this law?
No.

Md. Code Ann., Health Gen. § 20-103 (Enacted xxxx; Last Amended xxxx); Md. Code art. 1, § 24 (Enacted xxxx; Last Amended 2002).

Pro-Choice Laws:

Freedom of Choice Act

Maryland has created additional protections for reproductive rights by adding an affirmative right to choose into its state law. This law ensures women's access to pre-viability abortions and would remain in effect even if Roe v. Wade were overturned.

"[T]he state may not interfere with the decision of a woman to terminate a pregnancy: (1) Before the fetus is viable; or (2) At any time during the woman's pregnancy, if [t]he termination procedure is necessary to preserve the life or health of the woman; or . . . [t]he fetus is affected by a genetic defect or serious deformity or abnormality." Md. Code Ann., Health-Gen. § 20-209 (Enacted 1991).

Insurance Coverage for Contraception

Maryland law requires health insurance plans that cover prescription drugs to provide equitable coverage for contraception.

What is required?
If a health insurance plan provides coverage for prescription drugs, it must provide coverage for any Food and Drug-Administration-approved prescription contraceptive drug or device, insertion or removal of such drug or device, and any medically necessary exam associated with the use of such drug or device.

To which insurance plans does the law apply?
Insurance plans, nonprofit health service plans, and health maintenance organization (HMO) contracts that provide coverage for prescription drugs.

Does the law provide additional protections for women?
Yes. Insurers may not impose a different co-payment or coinsurance for contraceptives than that imposed on any other prescription drug.

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 contraceptive coverage conflicts with their bona fide religious beliefs and practices.

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

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?
Yes. By failing to define the term "religious employer," the law's refusal clause inappropriately includes a wide range of entities that perform non-religious functions in the public sphere.

Does the law require the refusing entity to notify the persons affected?
Yes. An employer exercising a refusal clause must provide employees reasonable and timely notice of the exclusion.

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

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

MD. Code Ann., Ins. § 15-826 (Enacted 1998).

Low-Income Women's Access to Abortion

Maryland prohibits public funding for abortion for women eligible for state medical assistance for general health care unless: (1) continuation of the pregnancy is likely to result in the woman's death; (2) the woman is a victim of rape, incest, or a sexual offense reported to a law enforcement, public health, or social agency; (3) the fetus is affected by a genetic defect or serious deformity or abnormality; (4) abortion is medically necessary because there is substantial risk that continuation of the pregnancy could have a serious and adverse effect on the woman's present or future physical health; or (5) continuation of the pregnancy is creating a serious effect on the woman's mental health and if carried to term there is substantial risk of serious or long lasting effect on the woman's future mental health. S.B. 125, 2004 Reg. Sess., 418th Gen. Assem. (Md. 2004); Md. Regs. Code tit. 10, §§ 09.02.04(G), 09.34.04(A)(5), 09.34.04(B)(2).

Protection Against Clinic Violence

A person who physically detains an individual or obstructs, impedes, or hinders an individual's passage, with the intent to prevent the individual from entering or exiting a medical facility, is guilty of a misdemeanor and may be fined up to $1000, imprisoned for up to 90 days, or both. Md. Code Ann., Crim. § 10-204 (Enacted 2002).

Other Relevant Laws

Post-Viability Abortion Restriction

Maryland's post-viability abortion restriction provides that abortion may be prohibited after viability unless necessary to preserve the woman's life or health or unless the fetus is affected by a genetic defect or serious deformity or abnormality. Md. Code Ann., Health-Gen. § 20-209 (Enacted 1991).

NARAL Pro-Choice America supports the legal framework established in Roe v. Wade and does not oppose restrictions on post-viability abortions, such as Maryland's, that contain adequate exceptions to protect the life and health of the woman.
 
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