Box v. Planned Parenthood: Indiana Law, Ruling, and Scope

In Box v. Planned Parenthood of Indiana and Kentucky, Inc. (2019), the Supreme Court upheld an Indiana requirement that abortion providers dispose of fetal remains by cremation or interment, and separately declined to review Indiana’s ban on abortions sought because of the fetus’s sex, race, or disability, leaving that ban blocked by a lower court injunction. The two provisions came from a single 2016 statute, House Enrolled Act 1337, but drew opposite outcomes at the Court.¹

The Indiana Law at Issue

HEA 1337 made two changes challenged in this case. First, under Indiana Code Chapter 16-34-3, clinics and healthcare facilities holding fetal remains had to arrange final disposition by cremation or interment rather than treating the material as infectious and pathological waste incinerated with other medical waste.² The rule governs the facility’s handling and does not affect a patient’s own right to choose the final disposition.¹

Second, under Indiana Code Chapter 16-34-4, a provider could not knowingly perform an abortion sought solely because of the fetus’s:

sex;³
race, color, national origin, or ancestry;⁴
diagnosis or potential diagnosis of Down syndrome or any other disability.⁵

Providers who knowingly or intentionally violated the ban faced disciplinary sanctions or civil liability for wrongful death.⁶

How the Court Ruled on the Disposal Requirement

The Court applied the rational basis test, which asks whether a law is reasonably linked to a legitimate government interest. It held that Indiana had a legitimate interest in the proper disposal of fetal remains and reversed the appellate ruling that had struck the provision down.¹ The injunction blocking the rule was lifted on September 3, 2019, and Indiana began enforcing the cremation and interment requirement.⁷

The Court was explicit about the limits of what it decided. Because the case was litigated only under rational basis, the opinion did not address whether such a rule might impose a burden on people seeking an abortion under a different legal standard.¹

Why the Court Left the Selective Abortion Ban Alone

On the ban covering sex, race, and disability, the Court denied the petition for review. That is a procedural choice, not a ruling on the merits, and it left the lower court injunction in place, so Indiana still could not enforce that portion of the statute against providers.¹

The Court said it was following its ordinary practice of waiting for additional appellate courts to weigh in before taking up a question. At that point only the Seventh Circuit had ruled on this kind of law. Justice Clarence Thomas wrote a concurring opinion discussing selective abortions and the state’s interest in preventing discriminatory practices. The underlying constitutional question about selective-trait bans was left for future litigation.¹

What the Decision Did and Did Not Settle

The practical takeaway from Box is narrow. Indiana’s disposal rule stands, tested only against rational basis, and applies to how facilities handle remains rather than to a patient’s own choices about disposition. The selective abortion ban was neither approved nor struck down by the Supreme Court; it simply remained unenforceable under the existing injunction while the question waited for further courts to address it.¹

1
Legal Information Institute. Box v. Planned Parenthood Opinion
2
Justia Law. Indiana Code § 16-34-3-4
3
Justia Law. Indiana Code § 16-34-4-5
4
Justia Law. Indiana Code § 16-34-4-6
5
Justia Law. Indiana Code § 16-34-4-7
6
Justia Law. Indiana Code § 16-34-4-9
7
Indiana Department of Health. Abortion Information Center