Complete Home & Office Legal Guide/Complete Home and Office Legal Guide (Chestnut) (1993).ISO/stat/ussct/abort3.asc

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    In Akron I, 462 U. S. 416 (1983), we invalidated an
ordinance which required that a woman seeking an abortion be
provided by her physician with specific information designed to
influence the woman's informed choice between abortion or
childbirth.  Id., at 444.  As we later described the Akron I
holding in Thornburgh v. American College of Obstetricians and
Gynecologists, 476 U. S., at 762, there were two purported flaws
in the Akron ordinance:  the information was designed to dissuade
the woman from having an abortion and the ordinance imposed a
rigid requirement that a specific body of information be givenin
all cases, irrespective of the particular needs of the
patient . . . .  Ibid.  To the extent Akron I and Thornburgh find
a constitutional violation when the government requires, as it
does here, the giving of truthful, nonmisleading information
about the nature of the procedure, the attendant health risks and
those of childbirth, and the probable gestational age of the
fetus, those cases go too far, are inconsistent with Roe's
acknowledgment of an important interest in potential life, and
are overruled.  This is clear even on the very terms of Akron I
and Thornburgh.  Those decisions, along with Danforth, recognize
a substantial government interest justifying a requirement that a
woman be apprised of the health risks of abortion and childbirth.
E.g., Danforth, supra, at 66-67.  It cannot be questioned that
psychological well-being is a facet of health.  Nor can it be
doubted that most women considering an abortion would deem the
impact on the fetus relevant, if not dispositive, to the
decision.  In attempting to ensure that a woman apprehend the
full consequences of her decision, the State furthers the
legitimate purpose of reducing the risk that a woman may elect an
abortion, only to discover later, with devastating psychological
consequences, that her decision was not fully informed.  If the
information the State requires to be made available to the woman
is truthful and not misleading, the requirement may be
permissible.

/* Ordinarily "the marketplace of ideas" would be allowed to
determine what is truth. Here the Court presumes that the state
will know to confine itself to the "truth" a reahter elusive
standard and one which invites litigation. */

    We also see no reason why the State may not require
doctors to inform a woman seeking an abortion of the availability
of materials relating to the consequences to the fetus, even when
those consequences have no direct relation to
her health.  An example illustrates the point.  We would think it
constitutional for the State to require that in order for there
to be informed consent to a kidney transplant operation the
recipient must be supplied with information about risks to the
donor as well as risks to himself or herself.  A requirement that
the physician make available information similar to that mandated
by the statute here was described in Thornburgh as an outright
attempt to wedge the Commonwealth's message discouraging abortion
into the privacy of the informed-consent dialogue between the
woman and her physician.  476 U. S., at 762.  We conclude,
however, that informed choice need not be defined in such narrow

terms that all considerations of the effect on the fetus are made
irrelevant.  As we have made clear, we depart from the holdings
of Akron I and Thornburgh to the extent that we permit a State to
further its legitimate goal of protecting the life of the unborn
by enacting legislation aimed at ensuring a decision that is
mature and informed, even when in so doing the State expresses a
preference for childbirth over abortion.  In short, requiring
that the woman be informed of the availability of information
relating to fetal development and the assistance available should
she decide to carry the pregnancy to full term is a reasonable
measure to insure an informed choice, one which might cause the
woman to choose childbirth over abortion.  This requirement
cannot be considered a substantial obstacle to obtaining an
abortion, and, it follows, there is no undue burden.

    Our prior cases also suggest that the strait- jacket,
Thornburgh, supra, at 762 (quoting Danforth, supra, at 67, n. 8),
of particular information which must be given in each case
interferes with a constitutional right of privacy between a
pregnant woman and her physician.  As a preliminary matter, it is
worth noting that the statute now before us does not require a
physician to comply with the informed consent provisions if he or
she can demonstrate by a preponderance of the evidence, that he
or she reasonably believed that furnishing the information would
have resulted in a severely adverse effect on the physical or
mental health of the patient.  18 Pa. Cons. Stat.  3205 (1990).
In this respect, the statute does not prevent the physician from
exercising his or her medical judgment.

    Whatever constitutional status the doctor- patient
relation may have as a general matter, in the present context it
is derivative of the woman's position.  The doctor-patient
relation does not underlie or override the two more general
rights under which the abortion right is justified: the right to
make family decisions and the right to physical autonomy.  On its
own, the doctor-patient relation here is entitled to the same
solicitude it receives in other contexts.  Thus, a requirement
that a doctor give a woman certain information as part of
obtaining her consent to an abortion is, for constitutional
purposes, no different from a requirement that a doctor give
certain specific information about any medical procedure.

    All that is left of petitioners' argument is an asserted
First Amendment right of a physician not to provide information
about the risks of abortion, and childbirth, in a manner mandated
by the State.  To be sure, the physician's First Amendment rights
not to speak are implicated, see Wooley v. Maynard, 430 U. S. 705
(1977), but only as part of the practice of medicine, subject to
reasonable licensing and regulation by the State.  Cf. Whalen v.
Roe, 429 U. S. 589, 603 (1977).  We see no constitutional
infirmity in the requirement that the physician provide the
information mandated by the State here.

    The Pennsylvania statute also requires us to reconsider
the holding in Akron I that the State may not require that a
physician, as opposed to a qualified assistant, provide
information relevant to a woman's informed consent.  462 U. S.,
at 448.  Since there is no evidence on this record that requiring
a doctor to give the information as provided by the statute would
amount in practical terms to a substantial obstacle to a woman
seeking an abortion, we conclude that it is not an undue burden.
Our cases reflect the fact that the Constitution gives the States
broad latitude to decide that particular functions may be
performed only by licensed professionals, even if an objective
assessment might suggest that those same tasks could be performed
by others.  See Williamson v. Lee Optical of Oklahoma, Inc., 348
U. S. 483 (1955).  Thus, we uphold the provision as a reasonable
means to insure that the woman's consent is informed.

    Our analysis of Pennsylvania's 24-hour waiting period
between the provision of the information deemed necessary to
informed consent and the performance of an abortion under the
undue burden standard requires us to reconsider the premise
behind the decision in Akron I invalidating a parallel
requirement.  In Akron I we said:  Nor are we convinced that the
State's legitimate concern that the woman's decision be informed
is reasonably served by requiring a 24-hour delay as a matter of
course.  462 U. S., at 450.  We consider that conclusion to be
wrong.  The idea that important decisions will be more informed
and deliberate if they follow some period of reflection does not
strike us as unreasonable, particularly where the statute directs
that important information become part of the background of the
decision.  The statute, as construed by the Court of Appeals,
permits avoidance of the waiting period in the event of a medical
emergency and the record evidence shows that in the vast majority
of cases, a 24-hour delay does not create any appreciable health
risk.  In theory, at least, the waiting period is a reasonable
measure to implement the State's interest in protecting the life
of the unborn, a measure that does not amount to an undue burden.

    Whether the mandatory 24-hour waiting period is
nonetheless invalid because in practice it is a substantial
obstacle to a woman's choice to terminate her pregnancy is a
closer question.  The findings of fact by the District Court
indicate that because of the distances many women must travel to
reach an abortion provider, the practical effect will often be a
delay of much more than a day because the waiting period requires
that a woman seeking an abortion make at least two visits to the
doctor.  The District Court also found that in many instances
this will increase the exposure of women seeking abortions to the
harassment and hostility of anti-abortion protestors
demonstrating outside a clinic.  744 F.  Supp., at 1351.  As a
result, the District Court found that for those women who have
the fewest financial resources, those who must travel long
distances, and those who have difficulty explaining their
whereabouts to husbands, employers, or others, the 24-hour
waiting period will be particularly burdensome.  Id., at 1352.

    These findings are troubling in some respects, but they
do not demonstrate that the waiting period constitutes an undue
burden.  We do not doubt that, as the District Court held, the
waiting period has the effect of increasing the cost and risk of
delay of abortions, id., at 1378, but the District Court did not
conclude that the increased costs and potential delays amount to
substantial obstacles.  Rather, applying the trimester
framework's strict prohibition of all regulation designed to
promote the State's interest in potential life before viability,
see id., at 1374, the District Court concluded that the waiting
period does not further the state interest in maternal health and
infringes the physician's discretion to exercise sound medical
judgment.  Id., at 1378.  Yet, as we have stated, under the undue
burden standard a State is permitted to enact persuasive measures
which favor childbirth over abortion, even if those measures do
not further a health interest.  And while the waiting period does
limit a physician's discretion, that is not, standing alone, a
reason to invalidate it.  In light of the construction given the
statute's definition of medical emergency by the Court of
Appeals, and the District Court's findings, we cannot say that
the waiting period imposes a real health risk.

/* It is unfair to rely on factual findings made under one view
of what the law considers the relevant facts to be and then find
that other facts were not found, proving the point under the new
law. If the lower Court had known that the case was to be studied
on an "undue burden" standard it might have found other facts.
The lower Court had no way to know that the tri-mester framework
was going out the door, and stopped there. */

    We also disagree with the District Court's conclusion
that the particularly burdensome effects of the waiting period on
some women require its invalidation.  A particular burden is not
of necessity a substantial obstacle.  Whether a burden falls on a
particular group is a distinct inquiry from whether it is a
substantial obstacle even as to the women in that group.  And the
District Court did not conclude that the waiting period is such
an obstacle even for the women who are most burdened by it.
Hence, on the record before us, and in the context of this facial
challenge, we are not convinced that the 24-hour waiting period
constitutes an undue burden.

    We are left with the argument that the various aspects of
the informed consent requirement are unconstitutional because
they place barriers in the way of abortion on demand.  Even the
broadest reading of Roe, however, has not suggested that there is
a constitutional right to abortion on demand.  See, e.g., Doe v.
Bolton, 410 U. S., at 189.  Rather, the right protected by Roe is
a right to decide to terminate a pregnancy free of undue
interference by the State.  Because the informed consent
requirement facilitates the wise exercise of that right it cannot
be classified as an interference with the right Roe protects.
The informed consent requirement is not an undue burden on
that right.

C

    Section 3209 of Pennsylvania's abortion law provides,
except in cases of medical emergency, that no physician shall
perform an abortion on a married woman without receiving a signed
statement from the woman that she has notified her spouse that
she is about to undergo an abortion.  The woman has the option of
providing an alternative signed statement certifying that her
husband is not the man who impregnated her; that her husband
could not be located; that the pregnancy is the result of spousal
sexual assault which she has reported; or that the woman believes
that notifying her husband will cause him or someone else to
inflict bodily injury upon her.  A physician who performs an
abortion on a married woman without receiving the appropriate
signed statement will have his or her license revoked, and is
liable to the husband for damages.

    The District Court heard the testimony of numerous expert
witnesses, and made detailed findings of fact regarding the
effect of this statute.  These included:

    273.  The vast majority of women consult their husbands
prior to deciding to terminate their pregnancy. . . .
    .    .    .    .    .

    "279.  The `bodily injury' exception could not be invoked
by a married woman whose husband, if notified, would, in her
reasonable belief, threaten to (a) publicize her intent to have
an abortion to family, friends or acquaintances; (b) retaliate
against her in future child custody or divorce proceedings; (c)
inflict psychological intimidation or emotional harm upon her,
her children or other persons; (d) inflict bodily harm on other
persons such as children, family members or other loved ones; or
(e) use his control over finances to deprive of necessary monies
for herself or her children. . . .
    .    .    .    .    .

    "281.  Studies reveal that family violence occurs in two
million families in the United States.  This figure, however, is
a conservative one that substantially understates (because
battering is usually not reported until it reaches
life-threatening proportions) the actual number of families
affected by domestic violence.  In fact, researchers estimate
that one of every two women will be battered at some time in
their life. . . .

    "282.  A wife may not elect to notify her husband of her
intention to have an abortion for a variety of reasons, including
the husband's illness, concernabout her own health, the imminent
failure of the marriage, or the husband's absolute opposition to
the abortion. . . .

    "283.  The required filing of the spousal consent form
would require plaintiff-clinics to change their counseling
procedures and force women to reveal their most intimate
decision-making on pain of criminal sanctions.  The
confidentiality of these revelations could not be guaranteed,
since the woman's records are not immune from subpoena. . . .

    "284.  Women of all class levels, educational
backgrounds, and racial, ethnic and religious groups are
battered. . . .

    "285.  Wife-battering or abuse can take on many physical
and psychological forms.  The nature and scope of the battering
can cover a broad range of actions and be gruesome and
torturous. . . .

    "286.  Married women, victims of battering, have been
killed in Pennsylvania and through- out the United States. . . .

    "287.  Battering can often involve a substantial amount
of sexual abuse, including marital rape and sexual
mutilation. . . .

    "288.  In a domestic abuse situation, it is common for
the battering husband to also abuse the children in an attempt to
coerce the wife. . . .

    "289.  Mere notification of pregnancy is frequently a
flashpoint for battering and violence within the family.  The
number of battering incidents is high during the pregnancy and
often the worst abuse can be associated with pregnancy. . . .
The battering husband may deny parentage and use the pregnancy as
an excuse for abuse. . . .

    "290.  Secrecy typically shrouds abusive families.
Family members are instructed not to tell anyone, especially
police or doctors, about the abuse and violence.  Battering
husbands often threaten their wives or her children with further
abuse if she tells an outsider of the violence and tells her that
nobody will believe her.  A battered woman, therefore, is highly
unlikely to disclose the violence against her for fear of
retaliation by the abuser. . . .

    "291.  Even when confronted directly by medical personnel
or other helping professionals, battered women often will not
admit to the battering because they have not admitted to
themselves that they are battered. . . .

    .    .    .    .    .
    "294.  A woman in a shelter or a safe house unknown to
her husband is not `reasonably likely' to have bodily harm
inflicted upon her by her batterer, however her attempt to notify
her husband pursuant to section 3209 could accidentally disclose
her whereabouts to her husband.  Her fear of future ramifications
would be realistic under the circumstances.

    "295.  Marital rape is rarely discussed with others or
reported to law enforcement authorities, and of those reported
only few are prosecuted. . . .

    "296.  It is common for battered women to have sexual
intercourse with their husbands to avoid being battered.  While
this type of coercive sexual activity would be spousal sexual
assault as defined by the Act, many women may not consider it to
be so and others would fear disbelief. . . .

    "297.  The marital rape exception to section 3209 cannot
be claimed by women who are victims of coercive sexual behavior
other than penetration.  The 90-day reporting requirement of the
spousal sexual assault statute, 18 Pa. Con. Stat. Ann. 3218(c),
further narrows the class of sexually abused wives who can claim
the exception, since many of these women may be psychologically
unable to discuss or report the rape for several years after the
incident. . . .

    "298.  Because of the nature of the battering
relationship, battered women are unlikely to avail themselves of
the exceptions to section 3209 of the Act, regardless of whether
the section applies to them." 744 F. Supp., at 1360-1362.

    These findings are supported by studies of domestic
violence.  The American Medical Association (AMA) has published a
summary of the recent research in this field, which indicates
that in an average 12-month period in this country, approximately
two million women are the victims of severe assaults by their
male partners.  In a 1985 survey, women reported that nearly one
of every eight husbands had assaulted their wives during the past
year.  The AMA views these figures as

          marked underestimates, because the nature of these
      incidents discourages women from reporting them, and
      because surveys typically exclude the very poor, those
      who do not speak English well, and women who are
      homeless or in institutions or hospitals when the
      survey is conducted.  Accord- ing to the AMA,
      [r]esearchers on family violence agree that the true
      incidence of partner violence is probably double the
      above estimates; or four million severely assaulted
      women per year.  Studies suggest that from one-fifth to
      one-third of all women will be physically assaulted by
      a partner or ex-partner during their lifetime.  AMA
      Council on Scientific Affairs, Violence Against Women 7
      (1991) (emphasis in original).

Thus on an average day in the United States, nearly 11,000 women
are severely assaulted by their male partners.  Many of these
incidents involve sexual assault.  Id., at 3-4; Shields &
Hanneke, Battered Wives' Reactions to Marital Rape, in The Dark
Side of Families: Current Family Violence Research 131, 144 (D.
Finkelhor, R. Gelles, G. Hataling, & M. Straus eds. 1983).  In
families where wife-beating takes place, moreover, child abuse is
often present as well.  Violence Against Women, supra, at 12.

    Other studies fill in the rest of this troubling picture.
Physical violence is only the most visible form of abuse.
Psychological abuse, particularly forced social and economic
isolation of women, is also common.  L. Walker, The Battered
Woman Syndrome 27-28 (1984).  Many victims of domestic violence
remain with their abusers, perhaps because they perceive no
superior alternative.  Herbert, Silver, & Ellard, Coping with an
Abusive Relationship: I. How and Why do Women Stay?, 53 J.
Marriage & the Family 311 (1991).  Many abused women who find
temporary refuge in shelters return to their husbands, in large
part because they have no other source of income.  Aguirre, Why
Do They Return? Abused Wives in Shelters, 30 J. Nat. Assn. of
Social Workers 350, 352 (1985).  Returning to one's abuser can be
dangerous.  Recent Federal Bureau of Investigation statistics
disclose that 8.8% of all homicide victims in the United States
are killed by their spouse.  Mercy & Saltzman, Fatal Violence
Among Spouses in the United States, 1976-85, 79 Am. J.  Public
Health 595 (1989).  Thirty percent of female homicide victims are
killed by their male partners.  Domestic Violence: Terrorism in
the Home, Hearing before the Subcommittee on Children, Family,
Drugs and Alcoholism of the Senate Committee on Labor and Human
Resources, 101st Cong., 2d Sess., 3 (1990).

    The limited research that has been conducted with respect
to notifying one's husband about an abortion, although involving
samples too small to be representative, also supports the
District Court's findings of fact.  The vast majority of women
notify their male partners of their decision to obtain an
abortion.  In many cases in which married women do not notify
their husbands, the pregnancy is the result of an extramarital
affair.  Where the husband is the father, the primary reason
women do not notify their husbands is that the husband and wife
are experiencing marital difficulties, often accompanied by
incidents of violence.  Ryan & Plutzer, When Married Women Have
Abortions: Spousal Notification and Marital Interaction, 51 J.
Marriage & the Family 41, 44 (1989).

    This information and the District Court's findings
reinforce what common sense would suggest.  In well-functioning
marriages, spouses discuss important intimate decisions such as
whether to bear a child.  But there are millions of women in this
country who are the victims of regular physical and psychological
abuse at the hands of their husbands.  Should these women become
pregnant, they may have very good reasons for not wishing to
inform their husbands of their decision to obtain an abortion.
Many may have justifiable fears of physical abuse, but may be no
less fearful of the consequences of reporting prior abuse to the
Commonwealth of Pennsylvania.  Many may have a reasonable fear
that notifying their husbands will provoke further instances of
child abuse; these women are not exempt from 3209's notification
requirement.  Many may fear devastating forms of psychological
abuse from their husbands, including verbal harassment, threats
of future violence, the destruction of possessions, physical
confinement to the home, the withdrawal of financial support, or
the disclosure of the abortion to family and friends.  These
methods of psychological abuse may act as even more of a
deterrent to notification than the possibility of physical
violence, but women who are the victims of the abuse are not
exempt from 3209's notification requirement.  And many women who
are pregnant as a result of sexual assaults by their husbands
will be unable to avail themselves of the exception for spousal
sexual assault, 3209(b)(3), because the exception requires that
the woman have notified law enforcement authorities within 90
days of the assault, and her husband will be notified of her
report once an investigation begins.  3128(c).  If anything in
this field is certain, it is that victims of spousal sexual
assault are extremely reluctant to report the abuse to the
government; hence, a great many spousal rape victims will not be
exempt from the notification requirement imposed by 3209.

    The spousal notification requirement is thus likely to
prevent a significant number of women from obtaining an abortion.
It does not merely make abortions a little more difficult or
expensive to obtain; for many women, it will impose a substantial
obstacle.  We must not blind ourselves to the fact that the
significant number of women who fear for their safety and the
safety of their children are likely to be deterred from procuring
an abortion as surely as if the Commonwealth had outlawed
abortion in all cases.

    Respondents attempt to avoid the conclusion that 3209 is
invalid by pointing out that it imposes almost no burden at all
for the vast majority of women seeking abortions.  They begin by
noting that only about 20 percent of the women who obtain
abortions are married.  They then note that of these women about
95 percent notify their husbands of their own volition.  Thus,
respondents argue, the effects of 3209 are felt by only one
percent of the women who obtain abortions.  Respondents argue
that since some of these women will be able to notify their
husbands without adverse consequences or will qualify for one of
the exceptions, the statute affects fewer than one percent of
women seeking abortions.  For this reason, it is asserted, the
statute cannot be invalid on its face.  See Brief for Respondents
83-86.    We disagree with respondents' basic method of analysis.

    The analysis does not end with the one percent of women
upon whom the statute operates; it begins there.  Legislation is
measured for consistency with the Constitution by its impact on
those whose conduct it affects.  For example, we would not say
that a law which requires a newspaper to print a candidate's
reply to an unfavorable editorial is valid on its face because
most newspapers would adopt the policy even absent the law.  See
Miami Herald Publishing Co. v. Tornillo, 418 U.S. 241 (1974).
The proper focus of constitutional inquiry is the group for whom
the law is a restriction, not the group for whom the law is
irrelevant.

    Respondents' argument itself gives implicit recognition
to this principle, at one of its critical points.  Respondents
speak of the one percent of women seeking abortions who are
married and would choose not to notify their husbands of
their plans.  By selecting as the controlling class women who
wish to obtain abortions, rather than all women or all pregnant
women, respondents in effect concede that 3209 must be judged by
reference to those for whom it is an actual rather than
irrelevant restriction.  Of course, as we have said, 3209's real
target is narrower even than the class of women seeking abortions
identified by the State: it is married women seeking abortions
who do not wish to notify their husbands of their intentions and
who do not qualify for one of the statutory exceptions to the
notice requirement.  The unfortunate yet persisting conditions we
document above will mean that in a large fraction of the cases in
which 3209 is relevant, it will operate as a substantial obstacle
to a woman's choice to undergo an abortion.  It is an undue
burden, and therefore invalid.

    This conclusion is in no way inconsistent with our
decisions upholding parental notification or consent
requirements.  See, e.g., Akron II, 497 U.S., at ---; Bellotti v.
Baird, 443 U. S. 622 (1979) (Bellotti II); Planned Parenthood of
Central Mo. v.  Danforth, 428 U. S., at 74.  Those enactments,
and our judgment that they are constitutional, are based on the
quite reasonable assumption that minors will benefit from
consultation with their parents and that children will often not
realize that their parents have their best interests at heart.
We cannot adopt a parallel assumption about adult women.

    We recognize that a husband has a deep and proper concern
and interest . . . in his wife's pregnancy and in the growth and
development of the fetus she is carrying. Danforth, supra, at 69.
With regard to the children he has fathered and raised, the Court
has recognized his cognizable and substantial interest in their
custody. Stanley v. Illinois, 405 U. S. 645, 651-652 (1972); see
also Quilloin v. Walcott, 434 U. S. 246 (1978); Caban v.
Mohammed, 441 U. S. 380 (1979); Lehr v.  Robertson, 463 U. S. 248
(1983).  If this case concerned a State's ability to require the
mother to notify the father before taking some action with
respect to a living child raised by both, therefore, it would be
reasonable to conclude as a general matter that the father's
interest in the welfare of the child and the mother's interest
are equal.

    Before birth, however, the issue takes on a very
different cast.  It is an inescapable biological fact that state
regulation with respect to the child a woman is carrying will
have a far greater impact on the mother's liberty than on the
father- 's.  The effect of state regulation on a woman's
protected liberty is doubly deserving of scrutiny in such a case,
as the State has touched not only upon the private sphere of the
family but upon the very bodily integrity of the pregnant woman.
Cf.  Cruzan v. Director, Missouri Dept. of Health, 497 U.S., at
281.  The Court has held that when the wife and the husband
disagree on this decision, the view of only one of the two
marriage partners can prevail.  Inasmuch as it is the woman who
physically bears the child and who is the more directly and
immediately affected by the pregnancy, as between the two, the
balance weighs in her favor.  Danforth, supra, at 71.  This
conclusion rests upon the basic nature of marriage and the nature
of our Constitution:  [T]he marital couple is not an independent
entity with a mind and heart of its own, but an association of
two individuals each with a separate intellectual and emotional
makeup.  If the right of privacy means anything, it is the right
of the individual, married or single, to be free from unwarranted
governmental intrusion into matters so fundamentally affecting a
person as the decision whether to bear or beget a child.
Eisenstadt v. Baird, 405 U. S., at 453 (emphasis in original).
The Constitution protects individuals, men and women alike, from
unjustified state interference, even when that interference is
enacted into law for the benefit of their spouses.

    There was a time, not so long ago, when a different
understanding of the family and of the Constitution prevailed.
In Bradwell v. Illinois, 16 Wall.  130 (1873), three Members of
this Court reaffirmed the common-law principle that a woman had
no legal existence separate from her husband, who was regarded as
her head and representative in the social state; and,
notwithstanding some recent modifications of this civil status,
many of the special rules of law flowing from and dependent upon
this cardinal principle still exist in full force in most States.
Id., at 141 (Bradley J., joined by Swayne and Field, JJ.,
concurring in judgment).  Only one generation has passed since
this Court observed that woman is still regarded as the center of
home and family life, with attendant special responsibilities
that precluded full and independent legal status under the
Constitution.  Hoyt v. Florida, 368 U. S. 57, 62 (1961).  These
views, of course, are no longer consistent with our understanding
of the family, the individual, or the Constitution.

    In keeping with our rejection of the common-law
understanding of a woman's role within the family, the Court held
in Danforth that the Constitution does not permit a State to
require a married woman to obtain her husband's consent before
undergoing an abortion.  428 U. S., at 69.  The principles that
guided the Court in Danforth should be our guides today.  For the
great many women who are victims of abuse inflicted by their
husbands, or whose children are the victims of such abuse, a
spousal notice requirement enables the husband to wield an
effective veto over his wife's decision.  Whether the prospect of
notification itself deters such women from seeking abortions, or
whether the husband, through physical force or psychological
pressure or economic coercion, prevents his wife from obtaining
an abortion until it is too late, the notice require- ment will
often be tantamount to the veto found unconstitutional in
Danforth.  The women most affected by this law "those who most
reasonably fear the consequences of notifying their husbands that
they are pregnant" are in the gravest danger.

    The husband's interest in the life of the child his wife
is carrying does not permit the State to empower him with this
troubling degree of authority over his wife.  The contrary view
leads to consequences reminiscent of the common law.  A husband
has no enforceable right to require a wife to advise him before
she exercises her personal choices.  If a husband's interest in
the potential life of the child outweighs a wife's liberty, the
State could require a married woman to notify her husband before
she uses a postfertilization contraceptive.  Perhaps next in line
would be a statute requiring pregnant married women to notify
their husbands before engaging in conduct causing risks to the
fetus.  After all, if the husband's interest in the fetus' safety
is a sufficient predicate for state regulation, the State could
reasonably conclude that pregnant wives should notify their
husbands before drinking alcohol or smoking.  Perhaps married
women should notify their husbands before using contraceptives or
before undergoing any type of surgery that may have complications
affecting the husband's interest in his wife's reproductive
organs.  And if a husband's interest justifies notice in any of
these cases, one might reasonably argue that it justifies exactly
what the Danforth Court held it did not justify "a requirement of
the husband's consent as well.  A State may not give to a man the
kind of dominion over his wife that parents exercise over their
children. Section 3209 embodies a view of marriage consonant with
the common-law status of married women but repugnant to our
present understanding of marriage and of the nature of the rights
secured by the Constitution.  Women do not lose their
constitutionally protected liberty when they marry.  The
Constitution protects all individuals, male or female, married or
unmarried, from the abuse of governmental power, even where that
power is employed for the supposed benefit of a member of the
individual's family.  These considerations confirm our conclusion
that 3209 is invalid.

D

    We next consider the parental consent provision.  Except
in a medical emergency, an unemancipated young woman under 18 may
not obtain an abortion unless she and one of her parents (or
guardian) provides informed consent as defined above.  If neither
a parent nor a guardian provides consent, a court may authorize
the performance of an abortion upon a determination that the
young woman is mature and capable of giving informed consent and
has in fact given her informed consent, or that an abortion would
be in her best interests.

    We have been over most of this ground before.  Our cases
establish, and we reaffirm today, that a State may require a
minor seeking an abortion to obtain the consent of a parent or
guardian, provided that there is an adequate judicial bypass
procedure.  See, e.g., Akron II, 497 U. S., at ---; Hodgson, 497
U. S., at ---; Akron I, supra, at 440; Bellotti II, supra, at
643-644 (plurality opinion).  Under these precedents, in our
view, the one-parent consent requirement and judicial bypass
procedure are constitutional.

    The only argument made by petitioners respecting this
provision and to which our prior decisions do not speak is the
contention that the parental consent requirement is invalid
because it requires informed parental consent.  For the most
part, petitioners' argument is a reprise of their argument with
respect to the informed consent requirement in general, and we
reject it for the reasons given above.  Indeed, some of the
provisions regarding informed consent have particular force with
respect to minors: the waiting period, for example, may provide
the parent or parents of a pregnant young woman the opportunity
to consult with her in private, and to discuss the consequences
of her decision in the context of the values and moral or
religious principles of their family.  See Hodgson, supra, at
---.

E

    Under the recordkeeping and reporting require- ments of
the statute, every facility which performs abortions is required
to file a report stating its name and address as well as the name
and address of any related entity, such as a controlling or
subsidiary organization.  In the case of state-funded
institutions, the information becomes public.

    For each abortion performed, a report must be filed
identifying: the physician (and the second physician where
required); the facility; the referring physician or agency; the
woman's age; the number of prior pregnancies and prior abortions
she has had; gestational age; the type of abortion procedure; the
date of the abortion; whether there were any pre-existing medical
conditions which would complicate pregnancy; medical
complications with the abortion; where applicable, the basis for
the determination that the abortion was medically necessary; the
weight of the aborted fetus; and whether the woman was married,
and if so, whether notice was provided or the basis for the
failure to give notice.  Every abortion facility must also file
quarterly reports showing the number of abortions performed
broken down by trimester.  See 18 Pa. Cons. Stat. 3207, 3214
(1990).  In all events, the identity of each woman who has had an
abortion remains confidential.

    In Danforth, 428 U. S., at 80, we held that recordkeeping
and reporting provisions that are reasonably directed to the
preservation of maternal health and that properly respect a
patient's confidentiality and privacy are permissible.  We think
that under this standard, all the provisions at issue here except
that relating to spousal notice are constitutional.  Although
they do not relate to the State's interest in informing the
woman's choice, they do relate to health.  The collection of
information with respect to actual patients is a vital element of
medical research, and so it cannot be said that the requirements
serve no purpose other than to make abortions more difficult.
Nor do we find that the requirements impose a substantial
obstacle to a woman's choice.  At most they might increase the
cost of some abortions by a slight amount.  While at some point
increased cost could become a substantial obstacle, there is no
such showing on the record before us.

    Subsection (12) of the reporting provision requires the
reporting of, among other things, a married woman's reason for
failure to provide notice to her husband.  3214(a)(12).  This
provision in effect requires women, as a condition of obtaining
an abortion, to provide the Commonwealth with the precise
information we have already recognized that many women have
pressing reasons not to reveal.  Like the spousal notice
requirement itself, this provision places an undue burden on a
woman's choice, and must be invalidated for that reason.

VI

    Our Constitution is a covenant running from the first
generation of Americans to us and then to future generations.  It
is a coherent succession.  Each generation must learn anew that
the Constitution's written terms embody ideas and aspirations
that must survive more ages than one.  We accept our
responsibility not to retreat from interpreting the full meaning
of the covenant in light of all of our precedents.  We invoke it
once again to define the freedom guaranteed by the Constitution's
own promise, the promise of liberty.

    *    *    *

    The judgment in No. 91-902 is affirmed.  The judgment in
No. 91-744 is affirmed in part and reversed in part,and the case
is remanded for proceedings consistent with this opinion,
including consideration of the question of severability.

    It is so ordered.

    APPENDIX TO OPINION

Selected Provisions of the 1988 and 1989 Amendments to the
Pennsylvania Abortion Control Act of 1982

    18 PA. CONS. STAT. ANN. (1990).  "3203.  Definitions.
    .    .    .    .    .

    `Medical emergency.' That condition which, on the basis
of the physician's good faith clinical judgment, so complicates
the medical condition of a pregnant woman as to necessitate the
immediate abortion of her pregnancy to avert her death or for
which a delay will create serious risk of substantial and
irreversible impairment of major bodily function."

    "3205.  Informed Consent.
    "(a) General Rule. " No abortion shall be performed or
induced except with the voluntary and informed consent of the
woman upon whom the abortion is to be performed or induced.
Except in the case of a medical emergency, consent to an abortion
is voluntary and informed if and only if:  "(1) At least 24 hours
prior to the abortion, the physician who is to perform the
abortion or the referring physician has orally informed the woman
of: "(i) The nature of the proposed procedure or treatment and of
those risks and alternatives to the procedure or treatment that a
reasonable patient would consider material to the decision of
whether or not to undergo the abortion.

"(ii)    The probable gestational age of the unborn child at the time
the abortion is to be performed.

"(iii)    The medical risks associated with carrying her child to
term.

"(2)    At least 24 hours prior to the abortion, the physician who is
to perform the abortion or the referring physician, or a
qualified physician assistant, health care practitioner,
technician or social worker to whom the responsibility has been
delegated by either physician, has informed the pregnant woman
that:  "(i) The department publishes printed materials which
describe the unborn child and list agencies which offer
alternatives to abortion and that she has a right to review the
printed materials and that a copy will be provided to her free of
charge if she chooses to review it.

"(ii) Medical assistance benefits may be available for prenatal
care, childbirth and neonatal care, and that more detailed
information on the availability of such assistance is contained
in the printed materials published by the department.

"(iii) The father of the unborn child is liable to assist in the
support of her child, even in instances where he has offered to
pay for the abortion.  In the case of rape, this information may
be omitted.

/* Does the statute also point out that child support is not
collected in many cases? */

"(3) A copy of the printed materials has been provided to the
woman if she chooses to view these materials.

"(4) The pregnant woman certifies in writing, prior to the
abortion, that the information required to be provided under
para- graphs (1), (2) and (3) has been provided.  "(b) Emergency.
" Where a medical emergency compels the performance of an
abortion, the physician shall inform the woman, prior to the
abortion if possible, of the medical indications supporting his
judgment that an abortion is necessary to avert her death or to
avert substantial and irreversible impairment of major bodily
function.

    "(c) Penalty. " Any physician who violates the provisions
of this section is guilty of `unprofessional conduct' and his
license for the practice of medicine and surgery shall be subject
to suspension or revocation in accordance with procedures
provided under the act of October 5, 1978 (P.L.  1109, No. 261),
known as the Osteopathic Medical Practice Act, the act of
December 20, 1985 (P.L.  457, No. 112), known as the Medical
Practice Act of 1985, or their successor acts.  Any physician who
performs or induces an abortion without first obtaining the
certification required by subsection (a)(4) or with knowledge or
reason to know that the informed consent of the woman has not
been obtained shall for the first offense be guilty of a summary
offense and for each subsequent offense be guilty of a
misdemeanor of the third degree.  No physician shall be guilty of
violating this section for failure to furnish the information
required by subsection (a) if he or she can demonstrate, by a
preponderance of the evidence, that he or she reasonably believed
that furnishing the information would have resulted in a severely
adverse effect on the physical or mental health of the patient.

    "(d) Limitation on Civil Liability. " Any physician who
complies with the provisions of this section may not be held
civilly liable to his patient for failure to obtain informed
consent to the abortion within the meaning of that term as
defined by the act of October 15, 1975 (P.L. 390, No. 111), known
as the Health Care Services Malpractice Act." "3206.  Parental
Consent.

    "(a) General rule. " Except in the case of a medical
emergency or except as provided in this section, if a pregnant
woman is less than 18 years of age and not emancipated, or if she
has been adjudged an incompetent under 20 Pa. C.S. 5511 (relating
to petition and hearing; examination by court-appointed
physician), a physician shall not perform an abortion upon her
unless, in the case of a woman who is less than 18 years of age,
he first obtains the informed consent both of the pregnant woman
and of one of her parents; or, in the case of a woman who is
incompetent, he first obtains the informed consent of her
guardian.  In deciding whether to grant such consent, a preg-
nant woman's parent or guardian shall consider only their child's
or ward's best interests.  In the case of a pregnancy that is the
result of incest, where the father is a party to the incestuous
act, the pregnant woman need only obtain the consent of her
mother.

    "(b) Unavailability of parent or guardian. " If both
parents have died or are otherwise unavailable to the physician
within a reasonable time and in a reasonable manner, consent of
the pregnant woman's guardian or guardians shall be sufficient.
If the pregnant woman's parents are divorced, consent of the
parent having custody shall be sufficient.  If neither any parent
nor a legal guardian is available to the physician within a
reasonable time and in a reasonable manner, consent of any adult
person standing in loco parentis shall be sufficient.

    "(c) Petition to the court for consent. " If both of the
parents or guardians of the pregnant woman refuse to consent to
the performance of an abortion or if she elects not to seek the
consent of either of her parents or of her guardian, the court of
common pleas of the judicial district in which the applicant
resides or in which the abortion is sought shall, upon petition
or motion, after an appropriate hearing, authorize a physician to
perform the abortion if the court determines that the pregnant
woman is mature and capable of giving informed consent to the
pro- posed abortion, and has, in fact, given such consent.

    "(d) Court order. " If the court determines that the
pregnant woman is not mature and capable of giving informed
consent or if the pregnant woman does not claim to be mature and
capable of giving informed consent, the court shall determine
whether the performance of an abortion upon her would be in her
best interests.  If the court determines that the performance of
an abortion would be in the best interests of the woman, it shall
authorize a physician to perform the abortion.

    "(e) Representation in proceedings. " The pregnant woman
may participate in proceedings in the court on her own behalf and
the court may appoint a guardian ad litem to assist her.  The
court shall, however, advise her that she has a right to court
appointed counsel, and shall provide her with such counsel unless
she wishes to appear with private counsel or has knowingly and
intelligently waived representation by counsel."

    "3207.  Abortion Facilities.
    .    .    .    .    .
    "(b) Reports. " Within 30 days after the effective date
of this chapter, every facility at which abortions are performed
shall file, and update immediately upon any change, a report with
the department, containing the following information:  "(1)Name
and address of the facility.
"(2)Name and address of any parent, subsidiary or affiliated
organizations, corporations or associations.
"(3)Name and address of any parent, subsidiary or affiliated
organizations, corporations or associations having contempo-
raneous commonality of ownership, beneficial interest,
directorship or officership with any other facility.
The information contained in those reports which are filed
pursuant to this subsection by facilities which receive
State-appropriated funds during the 12-calendar-month period
immediately preceding a request to inspect or copy such reports
shall be deemed public information.  Reports filed by facilities
which do not receive State-appropriated funds shall only be
available to law enforcement officials, the State Board of
Medicine and the State Board of Osteopathic Medicine for use in
the performance of their official duties.  Any facility failing
to comply with the provisions of this subsection shall be
assessed by the department a fine of $500 for each day it is in
violation hereof."

    "3208.  Printed Information.

    "(a) General Rule. " The department shall cause to be
published in English, Spanish and Vietnamese, within 60 days
after this chapter becomes law, and shall update on an annual
basis, the following easily comprehensible printed materials:
"(1)Geographically indexed materials designed to inform the woman
of public and private agencies and services available to assist a
woman through pregnancy, upon child- birth and while the child is
dependent, including adoption agencies, which shall include a
comprehensive list of the agencies available, a description of
the services they offer and a description of the manner,
including telephone numbers, in which they might be contacted,
or, at the option of the department, printed materials including
a toll-free 24-hour a day telephone number which may be called to
obtain, orally, such a list and description of agencies in the
locality of the caller and of the services they offer.  The
materials shall provide information on the availability of
medical assistance benefits for prenatal care, childbirth and
neonatal care, and state that it is unlawful for any individual
to coerce a woman to undergo abortion, that any physician who
performs an abortion upon a woman without obtaining her informed
consent or without according her a private medical consultation
may be liable to her for damages in a civil action at law, that
the father of a child is liable to assist in the support of that
child, even in instances where the father has offered to pay for
an abortion and that the law permits adoptive parents to pay
costs of prenatal care, childbirth and neonatal care.

"(2) Materials designed to inform the woman of the probable
anatomical and physiological characteristics of the unborn child
at two-week gestational increments from fertilization to full
term, including pictures representing the development of unborn
children at two-week gestational increments, and any relevant
information on the possibility of the unborn child's survival;
provided that any such pictures or drawings must contain the
dimensions of the fetus and must be realistic and appropriate for
the woman's stage of pregnancy.  The materials shall be
objective, non-judgmental and designed to convey only accurate
scientific information about the unborn child at the various
gestational ages. The material shall also contain objective
information describing the methods of abortion procedures
commonly employed, the medical risks commonly associated with
each such procedure, and the medical risks commonly associated
with carrying a child to term.

"(b)Format. " The materials shall be printed in a typeface large
enough to be clearly legible.

"(c)Free distribution. " The materials required under this
section shall be available at no cost from the department upon
request and in appropriate number to any person, facility or
hospital."

    "3209.  Spousal Notice.

"(a) Spousal notice required. " In order to further the
Commonwealth's interest in promoting the integrity of the marital
relationship and to protect a spouse's interests in having
children within marriage and in protecting the prenatal life of
that spouse's child, no physician shall perform an abortion on a
married woman, except as provided in subsections (b) and (c),
unless he or she has received a signed statement, which need not
be notarized, from the woman upon whom the abortion is to be
performed, that she has notified her spouse that she is about to
undergo an abortion.  The statement shall bear a notice that any
false statement made therein is punishable by law.

    "(b) Exceptions. " The statement certifying that the
notice required by subsection (a) has been given need not be
furnished where the woman provides the physician a signed
statement certi- fying at least one of the following:
"(1) Her spouse is not the father of the child.  "(2)Her spouse,
after diligent effort, could not be located.

"(3)The pregnancy is a result of spousal sexual assault as
described in section 3128 (relating to spousal sexual assault),
which has been reported to a law enforcement agency having the
requisite jurisdiction.

"(4)The woman has reason to believe that the furnishing of notice
to her spouse is likely to result in the infliction of bodily
injury upon her by her spouse or by another individual.
Such statement need not be notarized, but shall bear a notice
that any false statements made therein are punishable by law.

"(c) Medical emergency. " The requirements of subsection (a)
shall not apply in case of a medical emergency.

"(d) Forms. " The department shall cause to be published, forms
which may be utilized for purposes of providing the signed
statements required by subsections (a) and (b).  The department
shall distribute an adequate supply of such forms to all abortion
facilities in this Commonwealth.

"(e) Penalty; civil action. " Any physician who violates the
provisions of this section is guilty of `unprofessional conduct,'
and his or her license for the practice of medicine and surgery
shall be subject to suspension or revocation in accordance with
procedures provided under the act of October 5, 1978 (P.L. 1109,
No. 261), known as the Osteopathic Medical Practice Act, the act
of December 20, 1985 (P.L. 457, No. 112), known as the Medical
Practice Act of 1985, or their successor acts.  In addition, any
physician who knowingly violates the provisions of this section
shall be civilly liable to the spouse who is the father of the
aborted child for any damages caused thereby and for punitive
damages in the amount of $5,000, and the court shall award a
prevailing plaintiff a reasonable attorney fee as part of costs."

"3214.  Reporting.

"(a) General rule. " For the purpose of promotion of maternal
health and life by adding to the sum of medical and public health
knowledge through the compilation of relevant data, and to
promote the Commonwealth's interest in protection of the unborn
child, a report of each abortion performed shall be made to the
department on forms prescribed by it.  The report forms shall not
identify the individual patient by name and shall include the
following information:

"(1) Identification of the physician who performed the abortion,
the concurring physician as required by section 3211(c-)

(2) (relating to abortion on unborn child of 24 or more weeks
gestational age), the second physician as required by section
3211(c)(5) and the facility where the abortion was performed and
of the referring physician, agency or service, if any.

"(2)The county and state in which the woman resides.

"(3)The woman's age.

"(4)The number of prior pregnancies and prior abortions of the
woman.

"(5)The gestational age of the unborn child at the time of the
abortion.

"(6)The type of procedure performed or prescribed and the date of
the abortion.

"(7)Pre-existing medical conditions of the woman which would
complicate pregnancy, if any, and if known, any medical
complication which resulted from the abortion itself.

"(8)The basis for the medical judgment of the physician who
performed the abortion that the abortion was necessary to prevent
either the death of the pregnant woman or the substantial and
irreversible impairment of a major bodily function of the woman,
where an abortion has been performed pursuant to section
3211(b)(1).

"(9)The weight of the aborted child for any abortion performed
pursuant to section 3211(b)(1).

"(10)Basis for any medical judgment that a medical emergency
existed which excused the physician from compliance with any
provision of this chapter.

"(11)The information required to be reported under section
3210(a) (relating to determination of gestational age).

"(12)Whether the abortion was performed upon a married woman and,
if so, whether notice to her spouse was given.  If no notice to
her spouse was given, the report shall also indicate the reason
for failure to provide notice.
    .    .    .    .    .

"(f) Report by facility. " Every facility in which an abortion is
performed within this Commonwealth during any quarter year shall
file with the department a report showing the total number of
abortions performed within the hospital or other facility during
that quarter year.  This report shall also show the total
abortions performed in each trimester of pregnancy.  Any report
shall be available for public inspection and copying only if the
facility receives State-appropriated funds within the
12-calendar-month period immediately preceding the filing of the
report.  These reports shall be submitted on a form prescribed by
the department which will enable a facility to indicate whether
or not it is receiving State-appropriated funds.  If the facility
indicates on the form that it is not receivingState-appropriated
funds, the department shall regard its report as confidential
unless it receives other evidence which causes it to conclude
that the facility receives State-appropriated funds."