462 U.S. 416 (1983)
In February 1978 the City Council of Akron enacted Ordinance No. 160-1978, entitled Regulation of Abortions.1 The ordinance set forth seventeen provisions regulating the performance of abortions.2 It became effective on May 1, 1978, with violations punishable as criminal misdemeanors.3
Five provisions were challenged in this litigation.4 Section 1870.03 required all abortions performed after the first trimester to occur in a hospital accredited by the Joint Commission on Accreditation of Hospitals or the American Osteopathic Association.5 Section 1870.05 required the informed written consent of one parent or legal guardian or a court order for abortions on unmarried minors under age fifteen.6 Section 1870.06 required the attending physician to orally inform the patient of the status of her pregnancy, fetal development, possible viability, physical and emotional complications, and available agencies, plus particular risks of her pregnancy and procedure.7 Section 1870.07 imposed a twenty-four-hour waiting period after signing the consent form.8 Section 1870.16 required fetal remains to be disposed of in a humane and sanitary manner.9
On April 19, 1978, three corporations operating abortion clinics in Akron and a physician who performed abortions at one clinic filed suit in the United States District Court for the Northern District of Ohio.10 The defendants were the city of Akron and three city officials.11 Two individuals intervened as parents of unmarried minor daughters of childbearing age.12
After a preliminary injunction on April 27, 1978, the District Court held a trial and in August 1979 invalidated four provisions including the parental consent requirement, the detailed informed consent provisions of § 1870.06(B), and the fetal remains rule while upholding the hospitalization requirement, other informed consent elements, and the waiting period.13
All parties appealed.14 The Court of Appeals for the Sixth Circuit affirmed in part and reversed in part. It affirmed the District Court's decision that the hospitalization requirement is constitutional and that the parental consent, § 1870.06(B), and fetal remains provisions are unconstitutional. The Court of Appeals reversed the District Court's decision on §§ 1870.06(C) and 1870.07, finding these provisions to be unconstitutional.15 Three petitions for certiorari were filed and the Supreme Court granted review in 1982.16
Whether a municipal ordinance may require that all second-trimester abortions be performed in a hospital?17
Under Roe v. Wade, after the first trimester the state may regulate the abortion procedure to the extent the regulation reasonably relates to preservation and protection of maternal health.18
No. Section 1870.03 requires all post-first-trimester abortions in an accredited full-service hospital.19 The requirement imposes a significant obstacle through doubled costs and reduced availability.20 Only nine second-trimester abortions occurred in Akron hospitals the year before trial.21 Updated medical evidence establishes that the D&E procedure can be performed safely in outpatient clinics during the early second trimester.22
The APHA and ACOG recognized this development.23 The city offered no justification for applying the rule throughout the entire trimester rather than limiting it to the period where the health interest is advanced.24
The hospitalization requirement is unconstitutional because it unreasonably infringes the woman's right to an abortion.25
Related opinions on this issue
Joined by Justice White And Justice Rehnquist
Justice O'Connor dissented from the invalidation of the hospitalization requirement.26 She argued that the trimester framework is unworkable because medical technology continually shifts the points at which state interests become compelling.27 She would apply the undue burden standard throughout pregnancy instead.28
Under that standard the hospitalization requirement imposes no undue burden.29 It rationally relates to the state's interest in maternal health.30 Akron hospitals had not denied any woman an abortion and nearby facilities remained available.31
Whether a municipal ordinance may require parental consent or a court order for abortions performed on unmarried minors under the age of fifteen without an alternative judicial bypass procedure?32
The State may not impose a blanket provision requiring the consent of a parent as a condition for abortion of an unmarried minor without providing an alternative procedure for case-by-case evaluation of the minor's maturity or best interests.33
No. Section 1870.05(B) requires either parental consent or a court order for minors under fifteen.34 The provision contains no express bypass procedure.35 The Ohio juvenile statute neither mentions abortion nor authorizes inquiry into maturity or best interests.36 The ordinance is not reasonably susceptible of a construction that supplies the required case-by-case evaluation of the minor's maturity.37
The parental consent provision is unconstitutional for lack of an adequate judicial bypass.38
Whether a municipal ordinance may require physicians to recite a detailed list of specific statements to patients to ensure informed consent for an abortion?39
A state may require informed consent and truthful disclosure of risks and alternatives.40
No. Section 1870.06(B) requires the physician to recite a script declaring that the unborn child is a human life from the moment of conception.41 It also demands a detailed description of the anatomical and physiological characteristics of the particular fetus.42 The script further includes a parade of possible complications that begins with the assertion that abortion is a major surgical procedure.43 These requirements extend well beyond general informed consent by attempting to persuade the woman to withhold consent altogether and by placing the physician in an inflexible straitjacket contrary to the teaching of Danforth.44
The detailed informed-consent script is unconstitutional.45
Whether a municipal ordinance may require a twenty-four-hour waiting period between the signing of a consent form and the performance of an abortion?46
A state may not impose an arbitrary and inflexible waiting period that increases cost and risk without advancing a legitimate interest in informed decision-making or maternal health.47
No. Section 1870.07 mandates a twenty-four-hour delay after signing the consent form.48 The District Court found the requirement forces two separate trips and increases cost.49 The city presented no evidence that the delay makes the procedure safer.50 Reflection can occur through physician counseling without a mandatory period.51 The physician already exercises medical judgment on timing.52
The waiting-period requirement is unconstitutional.53
Whether a municipal ordinance may require that fetal remains be disposed of in a humane and sanitary manner?54
A criminal statute regulating disposal of fetal remains must give fair notice of prohibited conduct.55
No. Section 1870.16 requires disposal in a humane and sanitary manner.56 The phrase suggests possible intent to mandate some form of decent burial of an embryo.57 This creates fatal uncertainty where criminal liability is imposed.58 The city failed to show the term is severable without altering the enacted provision.59
The fetal-remains disposal provision is unconstitutional for vagueness.60