What New Abortion Laws Mean for Parents, Pregnant People, and People Who Want to Get Pregnant
Robin Utz learned in November of 2016 that there was something wrong with her second-trimester pregnancy. Her baby, whom she named Grace, was conceived after multiple rounds of in-vitro fertilization and several miscarriages. But diagnosed with multicystic dysplastic kidney and given a zero percent chance of viability, Grace was terminated at 21 weeks and five days.
"Making it to birth—if she did—would have meant a very, very brief life of agony, and dying in our arms within minutes," says Utz, a project manager in health care. "I thought, 'What kind of life is that for Grace?' And what if it compromised my ability to conceive again? I already felt so instinctively maternal toward her, and to bring her into the world only to have her suffer and die in my arms was completely inhumane to me."
Utz lives in Missouri, where lawmakers could soon be considering legislation similar to a new Texas law that bans most abortions. She finds them cruel to both the woman and fetus. "It's certainly not going to make the lives of women suffering under these laws better or improve life for the unborn," says Utz, who also shares her experience on her website DefendingGrace.
The Texas law prohibits abortions once medical professionals can detect fetal cardiac activity. While courts have blocked similar restrictions elsewhere, Texas' law leaves enforcement up to private citizens through civil lawsuits, which could help it survive legal challenges. In Missouri, a 2019 law banning abortions as early as eight weeks of pregnancy currently remains tangled up in court.
This week, the U.S. Department of Justice sued the state of Texas over the ban, asserting the law is unconstitutional.
Announcing the lawsuit at a news conference in Washington, Attorney General Merrick Garland said the Texas law's "unprecedented" design seeks "to prevent women from exercising their constitutional rights by thwarting judicial review for as long as possible," adding that "the act is clearly unconstitutional under longstanding Supreme Court precedent."
Designed with the specific goal of making it more difficult for clinics to obtain federal court orders blocking its enforcement, the law instead creates criminal penalties for abortions conducted after a fetal heartbeat is detected. The Texas Legislature has further tasked private citizens with enforcing the law by bringing private litigation against clinics and anyone else who assists a person in obtaining an abortion after six weeks.
Since going into effect September 1, clinics across Texas have stopped offering abortions after six weeks, or have shuttered altogether.
"This kind of scheme to nullify the Constitution of the United States is one that all Americans—whatever their politics or party—should fear," Garland said, adding that Texas' legal approach could become a model for other states seeking to attack additional constitutional rights.
According to the Guttmacher Institute, a total of 19 states have enacted 97 restrictions on abortion since January, including 12 outright bans, with more likely to be passed in the coming months. Combined with the record number of measures restricting abortion access already passed this year, the reproductive health organization says that women in America are facing an "all-out assault" on abortion rights.
Following the Supreme Court's landmark 1973 Roe v. Wade decision, the current constitutional standard is that abortion is legal until a fetus could survive outside a person's womb—generally about 24 weeks into the pregnancy. "Heartbeat bills" ban all or most abortions once a heartbeat can be detected, leaving women with a prohibitively narrow window in which to confirm they are pregnant and have the procedure.
While the majority of these laws are not yet in effect and face numerous legal challenges, medical providers and women are already questioning what the rulings could mean for mothers and mothers-to-be.
How Abortion Bans Will Impact Parents Considering Another Pregnancy
In the U.S., nearly six in ten women having abortions are mothers. Women diagnosed with complications during a previous pregnancy are at significantly greater risk for those same complications with each subsequent pregnancy. These complications are often noted as maternal indications for considering abortion—meaning they include physical or mental disorders which may jeopardize the patient's health during pregnancy. Under existing law, doctors and geneticists work together with the patient to predict the risk, diagnose issues, and determine if termination of the pregnancy is advised.
One example of a previous complication that could affect a future pregnancy is preeclampsia, a leading cause of both maternal and infant mortality worldwide, which has increased by 25 percent in the United States in the last 20 years. According to Kara Boeldt, founder of EndPreeclampsia, the latest abortion bans allow for termination with "reasonable medical judgment," but fail to adequately define what that means. Previous conditions listed as maternal or fetal indications for considering abortion, like severe preeclampsia, may not qualify under these bills. If that is the case, a person who becomes extremely ill during pregnancy because of severe preeclampsia may not have the option of a safe abortion.
"This bill and others like it could have a chilling effect on survivors of preeclampsia concerned about having subsequent children," says Boeldt. "Women with a history of severe preeclampsia who know that they would have to become ill enough to qualify for the extremely limited 'health' exemptions written into these bills before being offered a life-saving abortion may decide that the risk is too great [to try to conceive again]."
Other people at risk for complications during pregnancy are those who have recently given birth. Getting pregnant again too soon (typically less than a year after giving birth) increases the risk of adverse outcomes for both the parent and baby, particularly following a stillbirth, hemorrhage, or surgical birth. It's recommended that parents wait 18 to 24 months to safely start trying to conceive again. In these patients, an abortion may be necessary to prevent things like placental abruption, premature birth, and congenital disorders.
And then there are families who simply can't afford to bring another child into the world. A 2016 report from the Guttmacher Institute found 75 percent of patients having abortions in 2014 were low-income. Many of them indicated "having a baby would interfere with their work, school, or ability to care for their other children." In a nation where nearly 50 percent of pregnancies each year are unintentional and the average annual cost of raising a child is currently about $14,000, the inability to access abortion threatens to trap these women and their families in compounding cycles of poverty.
How Abortion Bans Will Impact Pregnant People
Most people with a uterus find out they're pregnant between their fourth to seventh week of pregnancy—that can make some of them too late for a safe, legal abortion according to the Texas bill and others like it.
In the U.S., women die in pregnancy and labor more than any other country in the developed world. Of those 700 deaths annually, African Americans, American Indians, and Alaska Natives are nearly three times as likely as white women to die from a pregnancy-related cause. Access to a safe, legal abortion is life-saving for women during a high-risk pregnancy, which could otherwise cause maternal mortality.
Nearly 99 percent of abortions occur before 21 weeks. When one is needed later in pregnancy, it's often because of a highly complex circumstance. Though each state ban allows for exceptions for serious risks to a woman's health, none makes allowance for severe fetal anomalies.
Infections and complications that can seriously harm the life or fertility of the mother also fail to meet states' criteria. One example: ectopic pregnancy, in which the fertilized egg implants in the fallopian tubes outside the uterus. In Ohio, a bill was introduced in 2019 to require a procedure for an ectopic pregnancy "that is intended to reimplant the fertilized ovum into the pregnant woman's uterus." But that goes against science: according to the American College of Obstetricians and Gynecologists(ACOG), "an ectopic pregnancy cannot move or be moved to the uterus, so it always requires treatment." It's generally a non-viable pregnancy that often puts the mother's life at risk.
The bans may also put those experiencing a miscarriage at a higher risk of infection or even death. In 2019, the Michigan house and senate passed a bill banning a procedure used for abortion called dilation and evacuation (D&E), which is similar to a dilation and curettage (D&C) but performed during the second trimester. Physicians, lawmakers said, are only allowed to perform it to save a woman's life. Here's the problem: a D&E is also used to help a person who has had or are going through a miscarriage in their second trimester safely pass all of the tissue in the uterus. Studies reveal 15 to 20 percent of known pregnancies end in miscarriage. Without a D&E, some of these people are at a risk for blood clots and infection, putting their life or future fertility at risk.
While there was no mention in the Michigan bill of performing a D&E for miscarriage (as opposed to abortion), and the ban ultimately did not go into effect, it could have had serious repercussions. "For a woman who is dilated before 20 weeks, we call it an inevitable abortion," says Edward Miller, M.D., a clinical fellow in maternal-fetal medicine at University of California, San Francisco Health. In those cases, doctors may recommend emptying the uterus to prevent pain and bleeding. "Our ability to perform this procedure under these bans may be compromised," he says. There are situations, he adds, where a person can be miscarrying and still have a detectable fetal heartbeat. While most opt for aspiration or D&E (after 20 weeks), being compelled to endure the miscarriage until a fetal heartbeat is no longer detectable makes a person vulnerable to bacterial infection, pain, and bleeding. He also points to the emotional ramifications of being legally forced to carry a dying fetus.
In the meantime, people in marginalized communities will be most profoundly impacted by such restrictive laws because access to necessary medical care may not be available or affordable, explains Kecia Gaither, M.D.
"Marginalized women may not have the resources to travel out of state for care," says Dr. Gaither, a double board-certified physician in ob-gyn and maternal-fetal medicine and director of perinatal services at NYC Health + Hospitals/Lincoln in the Bronx, New York. "This represents an enormous problem to mothers, and to the children born, as well as a massive infrastructure problem in terms of the facilities that will be needed to care for these unwanted children and children with special needs. This also represents a hardship for any mother forced to bring forth a child and potentially take care of it."
As Robin Utz put it, even in a state as conservative as Missouri, luck and privilege were on her side when it came to her daughter's termination.
"I had a job that gave me time off, I didn't have other children to care for, I had insurance coverage," she says. "What if I didn't have insurance or was working multiple jobs I couldn't take time off from? What if I couldn't find transportation or care for my children or just couldn't afford it? The layers of privilege that played into my ability to give my daughter the gift of a peaceful passing are jaw-dropping. It was the heartbreak of my life, and yet we were still unbelievably lucky."
- RELATED: Top 7 Causes of Miscarriage
How Abortion Bans Will Impact the Maternal Death Rate
Restricting access to safe, legal abortion doesn't reduce the occurrence of abortions. Instead, it increases maternal morbidity "from botched abortions, from home abortions, from women using coat hangers or throwing themselves down stairs," says Dr. Miller.
Only 1 in 4 abortions are performed safely in nations where abortions are banned or only allowed to save a woman's life, according to a study by the World Health Organization and the Guttmacher Institute. And at least 22,800 women die from unsafe abortions annually.
"There's such a problem of lack of accountability in lawmakers when making these sweeping decisions that affect more than 50 percent of our population," says Dr. Miller. "They'll never be the ones looking into the eyes of a women pregnant with a fetus with fatal anomalies, or who's been raped or is carrying the product of incest and say that they have to carry that pregnancy to term. They'll never tell it to her face—they'll force the medical community to do it, and it's unbelievably cowardly."
How Abortion Bans Impact Healthcare Providers
As of original reporting in 2019, Dr. Miller regularly performed medically necessary pregnancy terminations. Reasons for those included a baby diagnosed with a lethal anomaly, the culling of a twin or multiple whose anomalies affect the survival rate of womb-mates, or maternal indications, including severe cardiac disease or a genetic disorder like Marfan syndrome. Dr. Miller noted he also performed abortions on people with aggressive cancer to avoid delaying treatment.
"From an access standpoint, more women are going to be hurt," said Dr. Miller. "More providers are going to be forced to offer a reduced standard of care to patients who deserve the highest. And more providers, myself included, are going to be faced with some really hard decisions: do you honor the oath you took, or do you give into the threat of repercussions for doing the right thing?"
While the Texas law does not contain any criminal penalties for providing what it terms "illegal abortions," it instead allows private citizens to sue abortion providers, in addition to anyone else who assists anyone in obtaining an abortion—be it someone who drove a woman to an abortion provider or financially assisted them in getting an abortion.
Dr. Gaither said she fears a "mass exodus" of providers from states with extreme bans in place, resulting in even worse outcomes for pregnant people. "Providers won't be available to care for these women already facing a dreadful rate of maternal mortality," she added.
Nonetheless, Dr. Miller did precisely the opposite: abortion bans happening across the country in 2019 inspired the San Franciscan to apply for a medical license in Alabama, his home state.
"I was born after the establishment of Roe v. Wade, so all I've known is an America with the presence of abortion rights," he said. "The decision [on the bans] really shook me—these were rights I believed were innate and that every American had, but in reality, they have to be fought for and voiced."
I have no sympathy for women complaining about not being able to get an abortion because they didn't want a child! There are plenty of ways to keep from getting pregnant and if a woman had a previous child and had complications from that pregnancy why not have her tubes tied or even a hysterectomy???Read More