SUPREME COURT OF THE UNITED STATES ALBERTO R GONZALES ATTORNEY GENERAL v LEROY CARHART et al ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OFAPPEALS FOR THE EIGHTH CIRCUIT ALBERTO R GONZALES ATTORNEY GENERAL v PLANNED PARENTHOOD FEDERATION OFAMERICA INC et al ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT JUSTICE KENNEDY delivered the opinion of the Court edited with footnotes and most citations omitted SA THE COMPLETE TEXT CAN BE FOUND AT 550 US 124 127 S CT 1610 2007 These cases require us to consider the validity of the Partial Birth Abortion Ban Act of 2003 Act 18 U S C 1531 a federal statute regulating abortion procedures Stenberg v Carhart 530 U S 914 2000 also addressed the subject of abortion procedures used in the later stages of pregnancy Compared to the state statute at issue in Stenberg the Act is more specific and more precise in its coverage We conclude the Act should be sustained In No 05 380 Carhart respondents are doctors who perform second trimester abortions These doctors filed their complaint against the Attorney General of the United States in the United States District Court for the District of Nebraska They challenged the constitutionality of the Act and sought a permanent injunction against its enforcement In 2004 after a 2 week trial the District Court granted a permanent injunction that prohibited the Attorney General from enforcing the Act in all cases but those in which there was no dispute the fetus was viable The Court of Appeals for the Eighth Circuit affirmed 413 F 3d 791 2005 We granted certiorari 546 U S 1169 2006 In No 05 1382 Planned Parenthood respondents are Planned Parenthood Federation of America Inc The Planned Parenthood entities sought to enjoin enforcement of the Act in a suit filed in the United States District Court for the Northern District of California Planned Parenthood Federation of Am v Ashcroft 320 F Supp 2d 957 2004 1 In 2004 the District Court held a trial spanning a period just short of three weeks and it too enjoined the Attorney General from enforcing the Act The Court of Appeals for the Ninth Circuit affirmed 435 F 3d 1163 2006 We granted certiorari IA The Act proscribes a particular manner of ending fetal life so it is necessary here as it was in Stenberg to discuss abortion procedures in some detail Three United States District Courts heard extensive evidence describing the procedures We refer to the District Courts exhaustive opinions in our own discussion of abortion procedures Abortion methods vary depending to some extent on the preferences of the physician and of course on the term of the pregnancy and the resulting stage of the unborn child s development Between 85 and 90 percent of the approximately 1 3 million abortions performed each year in the United States take place in the first three months of pregnancy which is to say in the first trimester The most common first trimester abortion method is vacuum aspiration otherwise known as suction curettage in which the physician vacuums out the embryonic tissue Early in this trimester an alternative is to use medication such as mifepristone commonly known as RU 486 to terminate the pregnancy The Act does not regulate these procedures Of the remaining abortions that take place each year most occur in the second trimester The surgical procedure referred to as dilation and evacuation or D E is the usual abortion method in this trimester Although individual techniques for performing D E differ the general steps are the same A doctor must first dilate the cervix at least to the extent needed to insert surgical instruments into the uterus and to maneuver them to evacuate the fetus The steps taken to cause dilation differ by physician and gestational age of the fetus A doctor often begins the dilation process by inserting osmotic dilators such as laminaria sticks of seaweed into the cervix The dilators can be used in combination with drugs such as misoprostol that increase dilation The resulting amount of dilation is not uniform and a doctor does not know in advance how an individual patient will respond After sufficient dilation the surgical operation can commence The woman is placed under general anesthesia or conscious sedation The doctor often guided by ultrasound inserts grasping forceps through the woman s cervix and into the uterus to grab the fetus The doctor grips a fetal part with the forceps and pulls it back through the 2 cervix and vagina continuing to pull even after meeting resistance from the cervix The friction causes the fetus to tear apart For example a leg might be ripped off the fetus as it is pulled through the cervix and out of the woman The process of evacuating the fetus piece by piece continues until it has been completely removed A doctor may make 10 to 15 passes with the forceps to evacuate the fetus in its entirety though sometimes removal is completed with fewer passes Once the fetus has been evacuated the placenta and any remaining fetal material are suctioned or scraped out of the uterus The doctor examines the different parts to ensure the entire fetal body has been removed Some doctors especially later in the second trimester may kill the fetus a day or two before performing the surgical evacuation They inject digoxin or potassium chloride into the fetus the umbilical cord or the amniotic fluid Fetal demise may cause contractions and make greater dilation possible Once dead moreover the fetus body will soften and its removal will be easier Other doctors refrain from injecting chemical agents believing it adds risk with little or no medical benefit The abortion procedure that was the impetus for the numerous bans on partial birth abortion including the Act is a variation of this standard D E For discussion purposes this D E variation will be referred to as intact D E The main difference between the two procedures is that in intact D E a doctor extracts the fetus intact or largely intact with only a few passes There are no comprehensive statistics indicating what percentage of all D Es are performed in this manner Intact D E like regular D E begins with dilation of the cervix Sufficient dilation is essential for the procedure To achieve intact extraction some doctors thus may attempt to dilate the cervix to a greater degree In an intact D E procedure the doctor extracts the fetus in a way conducive to pulling out its entire body instead of ripping it apart One doctor for example testified If I know I