Editing Intact dilation and extraction (section)

===Legality in the United States===
{{Main|Partial-Birth Abortion Ban Act}}

==== Federal law ====
Since 1995, led by [[Republican Party (United States)|Republicans]] in [[United States Congress|Congress]], the [[United States House of Representatives|U.S. House of Representatives]] and [[United States Senate|U.S. Senate]] have moved several times to pass measures banning the procedure. Congress passed two such measures by wide margins during [[Presidency of Bill Clinton|Bill Clinton's presidency]], but Clinton [[veto]]ed those bills in April 1996 and October 1997 on the grounds that they did not include health exceptions. Subsequent congressional attempts at overriding the veto were unsuccessful.

A major part of the legal battle over banning the procedure relates to health exceptions, which would permit the procedure in special circumstances. The 1973 Supreme Court decision ''[[Roe v. Wade]]'', which declared many state-level abortion restrictions unconstitutional, allowed states to ban abortions of post-viable fetuses unless an abortion was "necessary to preserve the life or health of the mother." The companion ruling, ''[[Doe v. Bolton]]'', upheld against a vagueness challenge a state law that defined health to include mental as well as physical health. The Court has never explicitly held, as a matter of constitutional law, that states have to allow abortions of post-viable fetuses if doing so is necessary for the woman's mental health, but many read ''Doe'' as implying as much. The concern that the health exception can be read so liberally partly explains why supporters of the Partial-Birth Abortion Ban Act did not want to include one.

In 2003, the [[Partial-Birth Abortion Ban Act]] (H.R. 760, S. 3) was signed into law; the House passed it on October 2 with a vote of 281–142, the Senate passed it on October 21 with a vote of 64–34, and President [[George W. Bush]] signed it into law on November 5.

Beginning in early 2004, the [[Planned Parenthood Federation of America]], the [[National Abortion Federation]], and abortion doctors in Nebraska challenged the ban in [[United States district court|federal district courts]] in the [[United States District Court for the Northern District of California|Northern District of California]], [[United States District Court for the Southern District of New York|Southern District of New York]], and [[United States District Court for the District of Nebraska|District of Nebraska]]. All three district courts ruled the ban unconstitutional that same year. Their respective [[United States court of appeals|federal courts of appeals]]&mdash;the [[United States Court of Appeals for the Ninth Circuit|Ninth Circuit]], [[United States Court of Appeals for the Second Circuit|Second Circuit]], and [[United States Court of Appeals for the Eighth Circuit|Eighth Circuit]], respectively&mdash;affirmed these rulings on appeal.

The three cases were all appealed to the [[Supreme Court of the United States|U.S. Supreme Court]], and were consolidated into the case ''[[Gonzales v. Carhart]]''. On April 18, 2007, the Supreme Court voted to uphold the Partial-Birth Abortion Ban Act by a decision of 5–4.<ref>{{cite news|first=Mark |last=Sherman |title=Court Backs ban on abortion procedure |date=April 18, 2007 |publisher=SFGate |url=http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2007/04/18/national/w070844D25.DTL&type=politics |access-date=2007-04-18 |url-status=dead |archive-url=https://web.archive.org/web/20071114231038/http://www.sfgate.com/cgi-bin/article.cgi?f=%2Fn%2Fa%2F2007%2F04%2F18%2Fnational%2Fw070844D25.DTL&type=politics |archive-date=November 14, 2007 }}</ref> Justice [[Anthony Kennedy|Kennedy]] wrote for the majority and was joined by Justices [[Clarence Thomas|Thomas]], [[Antonin Scalia|Scalia]], [[Samuel Alito|Alito]], and Chief Justice [[John G. Roberts|Roberts]]. A dissenting opinion was written by Justice [[Ruth Bader Ginsburg|Ginsburg]] and joined by Justices [[John Paul Stevens|Stevens]], [[David Souter|Souter]] and [[Stephen Breyer|Breyer]].

====State law====
Many states have [[Late-term abortion#Legal restrictions|bans on late-term abortions]] which apply to intact D&E if it is performed after [[Fetus#Viability|fetal viability]].

Many states have also passed bans specifically on intact D&E. The first was Ohio, which in 1995 enacted a law that referred to the procedure as ''dilation and extraction''. In 1997, the United States Court of Appeals for the Sixth Circuit found the law unconstitutional on the grounds that it placed a substantial and unconstitutional obstacle in the path of women seeking pre-viability abortions in the [[second trimester]].

Between 1995 and 2000, 28 more states passed Partial-Birth Abortion bans, all similar to the proposed federal bans and all lacking an exemption for the health of the woman. Many of these state laws faced legal challenges, with Nebraska's the first to reach decision in ''[[Stenberg v. Carhart]]''. The Federal District Court held Nebraska's statute unconstitutional on two counts. One being the bill's language was too broad, potentially rendering a range of abortion procedures illegal, and thus, creating an undue burden on a woman's ability to choose. The other count was the bill failed to provide a necessary exception for the health of the woman. The decision was appealed to and affirmed by both the Eighth Circuit and the Supreme Court in June 2000, thus resolving the legal challenges to similar state bans nationwide.

Since the ''Stenberg v. Carhart'' decision, Virginia, Michigan, and Utah have adopted legislation very similar to the Nebraska law overturned as unconstitutional. The Michigan law was similarly struck down for broadness and failure to provide a health exemption. Utah's law remains on the books, pending trial, but is unenforceable under a court-ordered preliminary injunction. Virginia's Law was initially ruled invalid, but was reversed and remanded to the District Court in the wake of the ''Gonzales v. Carhart'' decision, where it was upheld as constitutional. This is despite the fact the Virginia law criminalizes abortions for accidental or intentional intact D&E.

In 2000, Ohio introduced another "partial-birth abortion" ban. The law differed from previous attempts at the ban in that it specifically excluded D&amp;E procedures, while also providing a narrow health exception. This law was upheld on appeal to the Sixth Circuit in 2003 on the grounds that "it permitted the partial birth procedure when necessary to prevent significant health risks."

In 2003, the Michigan Senate introduced Senate Bill No. 395, which would have changed the definition of birth and therefore effectively ban intact D&E. The definition of birth as defined in the bill was that once any part of the body had passed beyond the introitus, it is considered a birth. The bill included an exemption for the mother's health. The bill was passed by both the Senate and House of Representatives but was vetoed by governor [[Jennifer Granholm]].<ref>{{Cite web |title=Michigan Legislature - Senate Bill 0395 (2003) |url=http://www.legislature.mi.gov/(S(kz3mkcpt1fo2oj3akzcg2bcc))/mileg.aspx?page=GetObject&objectname=2003-SB-0395 |access-date=2023-03-28 |website=www.legislature.mi.gov}}</ref>

====Clinical response to legal bans on the procedure====
Since the passage of the Partial-Birth Abortion Ban Act in the United States and similar state laws, providers of later abortions typically induce and document [[feticide|fetal death]] before beginning any later abortion procedure. Since the bans only apply to abortions of living fetuses, this protects the abortion providers from prosecution. The most common method of inducing fetal demise is to inject digoxin intrafetally or potassium chloride intrathoracically.<ref name=":02"/><ref>{{cite journal |last1=Diedrich |first1=J |last2=Drey |first2=E |last3=Society of Family |first3=Planning. |title=Induction of fetal demise before abortion. |journal=Contraception |date=June 2010 |volume=81 |issue=6 |pages=462–73 |doi=10.1016/j.contraception.2010.01.018 |pmid=20472112 |url=https://www.societyfp.org/_documents/resources/InductionofFetalDemise.pdf |access-date=17 November 2022 |language=en}}</ref>