Keith Mack
Abortion laws vary from country to country and state to state, with some countries only allowing abortion in specific circumstances. Medical reasons for abortion are usually due to concerns about the fetus's viability or disability, or the mother's ability to survive the pregnancy without injury. In the United States, abortion is banned in 14 states, with many other states having attempted to ban or severely restrict access. All of these bans have an exception to prevent the death of the pregnant person, and some include other exceptions, such as when there is a risk to the pregnant person's health, when the pregnancy is the result of rape or incest, or when there is a lethal fetal anomaly. However, these exceptions have often proven unworkable in practice, creating barriers to accessing abortion care and preventing physicians from providing medically appropriate care.
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What You'll Learn
Lethal foetal anomalies
In the United States, abortion is banned in 14 states, and many other states have attempted to ban or severely restrict access. All of these bans have an exception to prevent the death of the pregnant person, and some include other exceptions, such as when there is a lethal foetal anomaly. However, these health and life exceptions are often unworkable in practice and do not always include lethal foetal anomalies. For example, West Virginia and Indiana have banned abortions due to genetic anomalies, and South Carolina, Ohio, and Tennessee do not allow exceptions for fetal abnormalities.
The only state with a comprehensive list of conditions that fall under lethal foetal anomalies is Louisiana. However, since Louisiana has multiple abortion bans in effect, one of which does not include exceptions for fatal foetal anomalies, the applicability of this exception is unclear. Other states, like Indiana, provide general criteria, such as a life expectancy of less than three months for the baby after birth. This has been challenged in court, with plaintiffs arguing that common conditions like Tay-Sachs disease, which causes death very early in childhood, should be included.
The lack of clear and consistent exceptions for lethal foetal anomalies in abortion bans can create barriers to accessing abortion care, even in situations where exceptions should apply. This can place the health and lives of pregnant people at risk, as physicians may be prevented from providing medically appropriate care. For example, in Texas, lawmakers have clarified the "life of the mother" exception but have not addressed cases where the foetus won't survive. This has resulted in people like Lauren Hall, who had a non-viable pregnancy, having to leave the state to terminate her pregnancy.
The impact of these restrictive abortion laws is felt by those who are already marginalised, as health services are generally less accessible to people on low incomes, refugees, migrants, LGBTI people, and racialised and Indigenous communities. Restrictive laws also prevent healthcare providers from offering the best care options for their patients, going against good medical practice and their professional ethical responsibilities.
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Risk to the pregnant person's health
Abortion laws vary across different countries and states, with some laws only allowing abortion in specific circumstances. In the United States, abortion is banned in 14 states, with many other states attempting to implement similar restrictions. These bans typically include exceptions to prevent the death of the pregnant person and other health-related exceptions. However, these exceptions are often vague and difficult to interpret, leaving physicians in a challenging position when deciding whether to provide abortion care.
Physicians in states with abortion bans face legal risks, including prosecution, prison time, fines, and loss of their professional licenses if they provide abortion care. This has resulted in reluctance among physicians to offer abortion care, even when a pregnant person's health is at risk. The lack of specific clinical definitions of qualifying conditions in these laws further complicates the decision-making process.
Maternal-fetal medicine specialists recognise the value of abortion as a form of medical care, especially in complicated, high-risk pregnancies. Abortion can be medically necessary and life-saving in certain situations, such as when the pregnant person has a condition like pulmonary hypertension, which puts a significant strain on their body. In some cases, abortions are required for cancer treatment, as continuing the pregnancy could worsen the patient's prognosis.
Additionally, restrictive abortion laws disproportionately impact marginalised communities, including low-income individuals, refugees, migrants, LGBTI people, and racialised and Indigenous communities. These groups often face barriers in accessing health services, and restrictive abortion laws only serve to exacerbate these inequalities. The inaccessibility of quality abortion care risks violating the human rights of pregnant people, including the right to life, physical and mental health, and freedom from torture or cruel, inhuman, and degrading treatment.
The criminalisation and stigmatisation of abortion also affect healthcare workers, exposing them to stigmatisation, physical and verbal attacks, intimidation, and threats. As a result, they may be deterred from providing the best care options for their patients, as they struggle to navigate restrictive laws and their professional ethical responsibilities. Ultimately, the decision to have an abortion when facing a health risk should be made by the pregnant person in consultation with medical professionals, taking into account the individual's needs and health history.
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Pregnancy resulting from rape or incest
In the United States, abortion is banned in 14 states, and many other states have attempted to ban or severely restrict access to abortion. However, all of these bans have an exception to prevent the death of the pregnant person, and some include other exceptions, such as when the pregnancy is the result of rape or incest.
Rape and incest exceptions to state abortion bans or gestational limits are often restricted to abortions early in the pregnancy. For example, West Virginia, which has a total abortion ban, has an exception for pregnancies resulting from rape or incest, but only up to 8 weeks LMP (Last Menstrual Period). This means that, on average, a person who discovers they are pregnant at 5.5 weeks LMP would have only 2.5 weeks to find and secure an appointment with a physician, file a report of the assault to law enforcement, and retrieve a copy of the report to provide to the physician at least 48 hours before receiving the abortion.
Most rape or incest exceptions require involvement with law enforcement, which can restrict abortion access for those who have become pregnant as a result of sexual assault. In 5 of the states with rape or incest exceptions – Florida, Georgia, Idaho, Mississippi, and West Virginia – pregnant people must report the sexual assault to law enforcement before they can receive abortion care.
Outside of the United States, the majority of countries worldwide allow abortion in cases of rape and/or incest. For example, in its Technical Guidelines for Safe Abortion, Ethiopia explicitly removed evidentiary burden requirements from accessing abortion in cases of rape or incest, and clearly states that “[t]ermination of pregnancy shall be carried out based upon the disclosure of the woman whether rape or incest has occurred.”
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High-risk pregnancies
Abortion laws vary across different states and countries. In some countries, there are laws that only allow abortion under specific circumstances. These circumstances include when the pregnancy is the result of rape or incest, if there is a severe and fatal injury to the foetus, or if the pregnancy presents a threat to the life or health of the pregnant person. In the United States, abortion is banned in 14 states, and many other states have attempted to implement severe restrictions on access to abortion. However, all of these bans have an exception to prevent the death of the pregnant person, and some include other exceptions, such as when there is a risk to the health of the pregnant person or when there is a lethal fetal anomaly.
A high-risk pregnancy is one that involves increased health risks for the mother, the fetus, or both. Certain factors can contribute to a pregnancy being considered high-risk, including pre-existing health conditions, the mother's age, and lifestyle factors. For example, being under the age of 17 or over the age of 35 during pregnancy can be a factor in determining high-risk pregnancies. Additionally, lifestyle factors such as smoking, substance use, and alcohol consumption can play a role.
Pregnancy-related health conditions can also lead to a high-risk classification. These include conditions that develop during pregnancy, such as gestational diabetes, low birth weight, multiple gestation (twins or triplets), gestational hypertension, preeclampsia, and eclampsia. Placental conditions like placenta previa or placental abruption can also contribute to high-risk pregnancies. Previous preterm births or complications with previous pregnancies may be a factor as well.
Some specific examples of high-risk pregnancies include situations where the mother has an autoimmune disease, such as lupus or multiple sclerosis (MS). Kidney disease is another condition that can make a pregnancy high-risk, leading to potential complications like preterm delivery, low birth weight, and preeclampsia. Zika infection during pregnancy has also been linked to an increased risk of pregnancy loss, stillbirth, and congenital anomalies, such as microcephaly, which results in a smaller-than-normal head size in infants.
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Foetal viability
The US Supreme Court has affirmed a constitutional right to abortion until viability, but the lack of a precise definition of viability has left pregnant people vulnerable to varying state interpretations and criteria. The decision of whether a foetus is viable may be left to doctors, who may be required to perform tests to prove pre-viability. Some states require multiple doctors to certify these findings.
The limit of viability is the gestational age at which a prematurely born foetus has a 50% chance of long-term survival outside the womb. Advances in neonatal intensive care have lowered the limit of viability over time. However, there is currently no uniform gestational age that defines viability worldwide due to differing biomedical and technological capacities.
In the US, the right to abortion is limited by foetal viability. The Supreme Court has held that viability marks the earliest point at which a state's interest in fetal life is constitutionally adequate to justify a legislative ban on non-therapeutic abortions. This has led to the enactment of "foetal personhood" laws in several states, recognising that a foetus can be the victim of homicide, which undermines abortion provision.
In India, the decision to terminate a pregnancy after 20 weeks is shifted to doctors, and medical boards must be set up in "approved facilities" to allow or deny termination after this point. The Indian legal framework tilts towards the autonomy of the woman rather than the rights of the unborn child, and abortions have been allowed up to 24 or 27 weeks in certain cases.
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Frequently asked questions
Medical reasons for abortion include chromosomal and genetic abnormalities, structural abnormalities, and fetal reduction. Other reasons are pulmonary hypertension, cancer treatment, and ectopic pregnancy.
Abortion is currently banned in 14 US states, with many other states having attempted to ban or severely restrict access. All of these bans have an exception to prevent the death of the pregnant person, and some include other exceptions, such as when there is a risk to the health of the pregnant person, when the pregnancy is the result of rape or incest, and when there is a lethal fetal anomaly.
Barriers to accessing abortions include high costs, stigma, and the refusal of health workers to provide abortions based on personal conscience or religious belief. Additionally, restrictive laws and requirements that are not medically justified, such as criminalization, mandatory waiting periods, and biased counselling, further impede access.
Abortion is generally a safe healthcare intervention when carried out using a recommended method and by someone with the necessary skills. However, when people face barriers to accessing safe and timely abortions, they may resort to unsafe abortions, which carry significant physical health risks, including incomplete abortions, damage to the genital tract, and internal organ damage.
