When governments restrict abortion access, there are three common exceptions: rape, incest, and life/health of the mother.
And in case the US Supreme Court overturns Roe v. Wade, as seems likely, many Republicans have advocated for limiting or completely eliminating all of those exceptions.
The first two are self-explanatory, but the third one is more complicated starting with whether the law says “life of the mother” or “health of the mother.”
Just because a politician says they’ll create exemptions for the mother’s life, doesn’t mean it will actually protect women in all circumstances.
What Life Exceptions Mean
Life exceptions, at minimum, cover when a person would die if they were to continue carrying the pregnancy or give birth. The exception allows doctors to do the procedure if they deem it necessary.
Health exceptions are broader and can include mental health. From the Center for Reproductive Rights, “Some countries indicate abortion is permitted under broad health or therapeutic grounds, while others specify that abortion is permitted when a woman’s mental health is at risk. A small number of countries explicitly indicate that abortion is only permitted when pregnancy jeopardizes the woman’s physical health.”
The World Health Organization advises interpreting “health” as overall physical, mental, and social wellbeing, not just the presence of a disease or illness.
Doctors say the barrier of proving a woman absolutely would have died without terminating her pregnancy is difficult to overcome because risks aren’t always clear.
Dr. Lisa Harris in Michigan told NPR some common complications such as heart disease have a 20-30% chance of causing death during pregnancy.
“Is that enough of a chance [of death] or does it have to be more? I hate to even put it like that,” said Harris, who was a guest on Michigan Radio’s Stateside. “But is that enough of a chance of dying that that person would qualify under Michigan’s ban for a lifesaving abortion? Or would their risk of dying need to be 50% or 100%? And so those kinds of things are very unclear.”
Some risks don’t present or become life-threatening until later in pregnancy, she added.
Still, several antiabortion political figures in multiple states have called for narrowing these exceptions or removing them entirely. They argue doctors would be able to intervene in rare life-or-death situations because the death of the fetus isn’t the intention in those cases.
The real risk is whether medical professionals will feel confident terminating a pregnancy or managing a complication without being penalized—Oklahoma recently passed a law that would imprison doctors who perform abortions. Most doctors say emergency situations require quick thinking and action, and ambiguity about where the line is could be dangerous for patients because it could lead to waiting too long.
Many hospitals—particularly those with religious affiliations—restrict how doctors can treat miscarriages, and many women are referred elsewhere even in emergencies.
There’s also variation in how the laws can be written, and how specific they are.
Many laws include language about emergencies, but they don’t specify when something counts as an emergency.
For example, in Idaho, the exception is if the physician determines the abortion is necessary to prevent the death of the pregnant woman. Missouri’s exception is “medical emergency” and Tennessee allows abortion if necessary “to prevent the death of pregnant woman or prevent serious risk of substantial and irreversible impairment of major bodily function.”
Some states have criteria for judges to use when weighing doctors’ defenses for performing what they considered a medically necessary abortion. Some states require two doctors to sign off on the decision. Others require the doctor to obtain permission before terminating the pregnancy.
And pregnancy is not a low-risk condition. Existing medical conditions are often exaggerated, and multiple bodily systems are affected, even without complications such as preeclampsia or the water breaking early.
Maria Phillis, an obstetrician/gynecologist, told the Washington Post, “There’s not one button that says, ‘This one thing is threatening a woman’s life.’ A lot of it is a slow decline, and at what point is a physician empowered to say that there is an emergency?”
This also does not address that the United States’ maternal mortality risk is higher than any other industrialized country.
The problem has only worsened over time.
By 2019, 16 in 100,000 live births in Iowa ended in death, according to the Iowa Department of Public Health. In 1999, it was eight in 100,000.
For women of color in Iowa, the rate of pregnancy-related death was much higher than for white women. Black women died at a rate of 36.9 per 100,000 live births, Hispanic women died at a rate of 9.7 per 100,000 live births, and Asian/Pacific Islander women died at a rate of 23.5 per 100,000 live births. For white women, the rate was six deaths per 100,000 live births.
It doesn’t help that many OB/GYN units have closed across Iowa, creating deserts for accessing care.
Many doctors say this rate will increase as reproductive health care decisions are restricted in the United States. One study published last year found that pregnancy-related deaths would increase by 21% overall and 33% among Black women.
This will be because of more women peforming self-induced abortions, but also because of women not getting the health care they need because doctors are afraid of being prosecuted under strict anti-abortion laws.
Even if exceptions are allowed.
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