Planned Parenthood of Ind. & Ky., Inc. v. Comm'r of the Ind. State Dep't of Health, 896 F.3d 809

Background

In 2016 Indiana amended its abortion law (HEA 1337) to require an ultrasound and offer to allow the patient to view it at least 18 hours before the abortion, shifting the ultrasound from the day of the procedure to the day before and mandating the timing be concurrent with the state’s informed‑consent delivery.
Planned Parenthood of Indiana & Kentucky (PPINK) challenged the 18‑hour ultrasound timing, arguing it unduly burdens access to abortion; the district court granted a preliminary injunction and the Seventh Circuit affirmed.
PPINK operates many clinics statewide but only a small number provide abortions and have ultrasound equipment; limited clinic days and geographic distance mean some patients must travel long distances and/or miss work and secure extra childcare if required to make two visits.
The district court found substantial burdens on primarily low‑income and time‑sensitive patients: increased travel costs, lost wages, childcare, scheduling delays that could push patients past gestational limits, and confidentiality/safety concerns for abused patients.
The State’s evidence of benefit focused mostly on the utility of ultrasounds generally and on one physician’s anecdote that an 18‑hour delay might have caused a patient to change her mind; the court found almost no evidence that the 18‑hour timing itself produced meaningful benefits.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the 18‑hour timing of the ultrasound and consent imposes an undue burden on the right to pre‑viability abortion	PPINK: the timing forces many patients—especially low‑income and distant patients—to make an extra visit, causing significant financial, logistical, and safety burdens that block access.	State: 18‑hour delay furthers legitimate interests (promoting fetal life, women’s mental health) by giving time for reflection; waiting periods are commonly upheld.	The court held the 18‑hour timing imposes an undue burden in the Indiana context and affirmed the injunction.
Proper legal test for assessing the statute	PPINK: apply Casey/Whole Women’s Health balancing of burdens vs. benefits, analyzing actual record evidence.	State: urged a different or less exacting standard for informed‑consent/waiting laws.	Court: reaffirmed Casey/Whole Women’s Health undue‑burden balancing applies to all abortion regulations; courts must review record evidence.
Appropriate population and scope for burden analysis	PPINK: focus on the group for whom the provision is a real restriction—low‑income, geographically remote patients— and compare burdens/benefits of the 18‑hour timing specifically.	State: emphasized general legitimacy of waiting periods and ultrasound benefits for all patients.	Court: considered the affected subgroup and weighed burdens of the 18‑hour timing against evidence of benefit from that timing specifically.
Whether mitigation (provider could buy machines/train staff) defeats claim of undue burden	PPINK: mitigation is impractical or unsustainable given costs, limited staff, and mission constraints; courts should not micromanage providers.	State: PPINK could adapt business decisions—buy machines, train staff, accept outside ultrasounds—to avoid burden.	Court: rejected mitigation as dispositive; decline to rewrite provider business model and credited PPINK’s resource constraints.

Key Cases Cited

Roe v. Wade, 410 U.S. 113 (1973) (establishes constitutional right to choose abortion pre‑viability).
Planned Parenthood of Se. Pa. v. Casey, 505 U.S. 833 (1992) (adopts undue‑burden standard; courts must weigh burdens against state interests).
Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016) (reiterates Casey balancing and requires courts to assess record evidence of benefits and burdens).
Planned Parenthood of Wisc., Inc. v. Schimel, 806 F.3d 908 (7th Cir. 2015) (applies undue‑burden analysis to facility/credentialing restrictions; courts consider realistic burdens).
Karlin v. Foust, 188 F.3d 446 (7th Cir. 1999) (context‑specific inquiry: similar waiting periods may be upheld or struck down depending on state facts).