Opposing State Abortion Bans Due to their Impact on Women's Rights and Health
Written in October 2019 by the Women's Caucus Policy Committee lead by Dr. Sarah Gareau and Cherise Charleswell
All across the country, leaders are speaking out against these unprecedented attacks on our rights and freedoms. This week we saw hundreds of thousands attend more than 500 events nationwide and make their voices heard — that’s not going to stop. Today, I am proud to stand alongside our reproductive health champions in Congress who are ready to fight back against these dangerous bans. With our dedicated partners, we will continue to lead the charge to reject this extreme, unethical, and unconstitutional assault on abortion care—which is health care— no matter what.
—Statement from Dr. Leana Wen, Former President and CEO, Planned Parenthood Federation of America, May 23, 2019
The statement made by Dr. Leana Wen painstakingly describes the battle to ensure reproductive rights for women in the United States, which continues to be a laborious struggle, and access to abortion is at the center of this fight. During the first few months of 2019 a number of state legislatures have proposed or passed legislation that focus on curtailing women’s access to safe and affordable abortions, and in a number of cases, this includes total bans, which are more commonly referred to as “fetal heart beat bills”. These measures generally prohibit abortion procedures after doctors can discern a fetal heartbeat, a milestone that they legislators argue, happens around six weeks of pregnancy — before some women know they are pregnant.
Among the many critical problems with these fetal heart beat bills is that the tenets that they are based on are scientifically inaccurate. Abortion is a safe medical procedure. While bans put women’s lives at risk and contribute to a reduction in their overall well-being. Further, limitations to abortion rights restrict women’s fundamental self-determination and control over their bodies, lives, and destinies; their inalienable human rights. It is for these reasons, the Women’s Caucus in official relationship with the American Public Health Association equivocally stands in opposition to the proliferation of state abortion bans across the United States.
The Women’s Caucus in official relationship with The American Public Health Association unequivocally opposes the proposition and passing of scientifically unsound Fetal Heartbeat Bills and other restrictive abortion bans that strip away American women’s reproductive rights, access to women’s health provisions, and full body autonomy.
We take this stand due to our commitment to advocate for women’s physical, mental, and socioeconomic health. Women have a fundamental human right to reproductive health and full autonomy over their bodies.
Due to these commitments we are in support of comprehensive sex education, as well as access to affordable reproductive care and comprehensive women's health provisions, including the Affordable Care Act. We are ultimately in support of universal health care, as we believe that it would be the most effective means of ensuring all women, particularly those who are under-resourced with equitable access to health services.
We want to center social determinants of health in discussions on reproductive rights, and recognize the fact that young women of childbearing age — the Millennials (born after 1980) currently cope with extreme levels of debt (particularly those tied to student loans), stagnant wages, yet rising costs of living, which means that these generations of Americans actually have a lower standard of living, and thus reduced health outcomes than their parents and grandparents. In fact, estimates have shown that American millennials are saddled with more than $1 trillion in debt, which is mostly tied to student loans, and this debt certainly will directly impact their quality of life, and has been connected to rising homelessness and other public health issues.
These conditions have understandably led to decisions to have no children or fewer children. (Henshaw, 2009) The number of babies born in the U.S. has continued to fall over the past decade, and Americans are now having fewer children than it takes to replace the population. This all underlines the urgent and continued need for access to safe abortions; particularly for under resourced women.
We demand the implementation of policies that improve the economy, such as increases in minimum wage (or establishing living wages), implementing rent control, particularly in areas where renters and others are spending well over 50% of their income on housing costs, expanding the Affordable Care Act and helping to reduce health care costs, creating more and expanding student loan forgiveness programs; in order to alleviate economic pressures on women of childbearing age, which make safe abortions a necessity.
We stand with women who have made the decision to opt out of motherhood. And we are against social stigmas that are placed against childless women, recognizing that there is much more that is meaningful in life, other than bearing children.
Ultimately, the decision to undergo an abortion is a decision that must only be made by women. Men simply do not have a right to decide what women choose for their bodies and lives.
The Women’s Caucus collectively issues this statement to continue the fight for reproductive rights and to call for the protection of access to safe and legal abortions.
Call to Action:
We welcome members of the APHA Women’s Caucus, as well as other APHA members, Sections, Forums, Spigs, Caucuses, and task forces to join us by signing-on to this statement.
We urge the legislators and Governors of the states of Georgia, Alabama, Missouri, Ohio, Mississippi, South Carolina, and Kentucky to reconsider, repeal, and/or not move forward with signing into law, restrictive abortion bans that will result in the unnecessary criminalization of women, stripping women of bodily autonomy and their human rights, as well as detrimental health consequences.
We urge federal, state, tribal, municipal governments, foundations, and other stakeholders to provide women and girls in their communities access to free and/or affordable family planning and comprehensive sex education, as the base for reproductive options.
We urge federal, state, tribal, municipal governments, foundations, stakeholders in the private sector to continue to fund programs that ensure women’s reproductive rights and access to reproductive health care, including safe abortions.
We call on District Attorney offices to not move forward with criminalizing and prosecuting women who seek out safe abortions, particularly outside of their state of origin; and especially when no actions will be carried out against the men whom play a part in conception.
We call on Congress to investigate the legality of the recently-passed restrictive and thus dangerous abortion bans.
We urge members of the Women’s Caucus to contact your Congressional representatives and express your displeasure and concerns over these restrictive abortion bans. You can utilize Gov.track to find your Representative and Senators. If you are a resident of a state where the legislation has passed through your Legislature, we urge you to contact the Governor’s office.
Although this statement is being released by the Women’s Caucus (in official relationship with APHA), the views shared do not represent the viewpoints of individual members of the Caucus or APHA. This is a consensus statement.
These restrictive abortion bans have been proposed and/or passed through legislatures in the following states: Georgia, Ohio, Missouri, Alabama, Mississippi, Kentucky, and South Carolina, and they represent a growing momentum to fundamentally rollback women’s reproductive rights in the United States. The proliferation of legislation includes the following:
Kentucky Ban: On February 14, 2019 the Kentucky Senate with a vote of 31 to 6, passed SB 9. The measure is another heartbeat abortion ban, requiring anyone seeking an abortion to first determine if a fetal heartbeat is detectable; and would have narrow exceptions — mother’s life is endangered. It would also make it a felony to perform or induce and abortion when a fetal heartbeat has been detected. The bill was signed by Kentucky Governor Matt Bevin on March 15, 2019; and is currently temporarily blocked in federal court.
Ohio ban: On April 11, 2019, Ohio Governor Mike DeWine signed SB 23, often referred to as the Heartbeat Bill into law. It is an extremely stringent abortion ban, which bans abortions after a detectable fetal heartbeat; which doctors say can be as early as six weeks into pregnancy, before many women know they are pregnant. The ban was temporarily blocked by a Federal judge on July 3, 2019.
Georgia ban: On May 7, 2019, Georgia Governor signed into law House Bill 481. The omnibus abortion bill essentially adds fertilized eggs, embryos and fetuses in the definition of protected persons, limits abortion to the moment alleged fetal cardiac activity is detected (which may occur before a woman knows that she is pregnant), and thus repeals a woman’s constitutional rights to privacy. It is a near-total ban, banning abortion after six weeks of pregnancy, and is set to begin in 2020. If upheld, the bill stands to become one of the most restrictive abortion laws in the country. The bill is also currently temporarily blocked in federal court.
Texas State Senate: On May 13, 2019 the Texas State Senate passed the Severe Fetal Disability Abortion Ban (SB 1033). SB 1033 will do away with an exception in the state’s 20-week abortion ban that currently allows pregnant women facing severe fetal disease or disability – an already traumatic event – to undergo abortion; and would require women to be informed of “perinatal palliative care” programs. The bill now moves to the House State Affairs Committee.
Alabama ban: On May 14, 2019 with a vote of 25 to 6, the Alabama Senate passed a total abortion ban HB 314, with the only exception being when the health of the pregnant woman is at serious risk. An attempt to expand these exemptions to include rape or incest was decided against in a vote of 21 to 11. All of the four women in the Alabama Senate voted against the ban. The ban makes it a felony to terminate a pregnancy at any point, and providers could face jail time of 10 to 99 years for providing abortions. Patients are exempt from criminal and civil charges. Alabama Governor, Kay Ivey, a woman, signed the Bill into law on May 16, 2019, as the Human Life Protection Act. The measure is scheduled to go into effect in November 2019; but this may be halted by lawsuits brought forth by American Civil Liberties Union and Planned Parenthood, who have requested a preliminary injunction. There is also the chance of a temporary restraining order that would halt the law from being implemented until May 2020.
Missouri ban: On May 17, 2019, Missouri’s House passed HB 126, which would be among the most restrictive abortion bans in the United States; banning abortions at eight weeks of pregnancy. While the legislation includes exceptions for medical emergencies, there are no exceptions for cases of rape or incest. Medical providers would also be criminalized, and face five to 15 years in prison for violating the eight-week cutoff for abortions. In expectation of challenges to their Bill by Courts, the Missouri legislators have included a ladder of less-restrictive time limits - prohibiting abortion at 14, 18, or 20 weeks of pregnancy. On August 28, 2019 a Federal judge temporarily blocked a part of the "Missouri Stands for the Unborn Act" anti-abortion legislation. Doctors at Planned Parenthood of St. Louis, the last remaining abortion clinic in the state, will need to adhere to a so-called "reason" ban, a law that prohibits women from terminating pregnancies based solely on race, sex or a "prenatal diagnosis, test, or screening indicating Down Syndrome or the potential of Down Syndrome."
Mississippi Ban: On March 21, 2019, Governor Phil Bryant signed into law SB 2116, a measure that bans abortions in the state of Mississippi once a fetal heartbeat can be detected — about six weeks in to pregnancy. Abortions would be allowed after a fetal heartbeat is detected only if a pregnancy endangers a woman’s life or major bodily functions. No exceptions are made for pregnancies caused by rape or incest. Medical providers who terminate a pregnancy under the ban could face revocation of their Mississippi medical license. The bill was blocked by a Federal judge on May 24, 2019.
South Carolina Ban: On April 24, 2019, the SC House voted in favor of House Bill 3020, a 6-week abortion ban, while the SC legislature was not in session. The House voted for the fetal heartbeat legislation, in this manner to circumvent the system. On October 22, 2019 the SC Senate Medical Affairs Committee voted to add an amendment to the bill to remove exceptions for women who were victims of rape or incest. The amended bill passed with a vote of 4-3 and now moves on to the full Senate Medical Affairs Committee for a vote. If the committee passes the bill, it goes to the entire Senate.
We should recognize that fetal heart beat bills and other restrictive abortion bans may and/or should be deemed unconstitutional and in direct conflict with Roe v. Wade, the landmark legislation, signed into law by the United States Supreme Court in 1973, which affirmed that access to safe and legal abortion is a constitutional right. Thus, it is a great concern that these varied and growing state abortion bans may be laying the foundation for, and may be hinting towards, a legal challenge or overturning of Roe v. Wade. These actions are only building on legislation such as The Hyde Amendment of 2003, an existing Federal law that prohibits the use of federal funding for abortion services other than to save a woman’s life. The Hyde Amendment essentially criminalizes second-trimester abortions that are medically safe and in some cases the best course of action to protect the health of a woman. The Hyde Amendment was upheld by the Supreme Court in 2007. This partial Federal ban and the recent restrictive state bans on abortion, not only signify a regression on women’s human rights and bodily autonomy in the United States, but will also have drastic and negative impacts on the health and wellbeing of women.
The Scientific Reality:
There is no fetus, and thus no fetal heartbeat within six weeks of pregnancy. Instead, blastocyte cells form an embryo, which has the first nerve cells, which are able to produce a little flutter in the area that may later become the heart. There is no heart formed at this time, and these heartbeat bans are simply being enacted on the basis of the electrical activity running through embryonic cells. Ultimately, the “heartbeat bans” are nothing more than a ploy to put additional barriers between a woman and the health care she needs.
Banning abortion early in pregnancy would have devastating effects on the health and wellbeing of women and their families. In most cases the women who have abortions are already mothers so they are knowledgeable about the physical, emotional and financial demands of pregnancy and child-rearing. Consequently, the decision not to continue a pregnancy is well-informed and based in the reality of current circumstances (Henshaw, 2009).
We must oppose abortion bans, regardless of what they’re called, and realize that we must uphold a woman’s right to an abortion, even in cases outside of rape or when the mother’s life is threatened. Women should be supported in their right to terminate a pregnancy, simply because they are unprepared or unwilling to be a mother, or have another child.
How These Bills Will Encroach Upon Women’s Rights:
Treating fertilized eggs, embryos and fetuses as if they are physically and legally independent of the women who carry them, instantly strips women of their fundamental constitutional and inalienable rights; particularly their right of choice, and deciding what will take place with their own bodies. Along with the right to life (especially in cases where proceeding with a pregnancy puts the mother’s life at risk) and liberty.
A number of these bills will criminalize women who pursue or carry out an abortion, even if the procedure is carried out outside of the state. This is due to the fact that a number of these bills grant state actors with the power to control, detain, arrest, prosecute, and effectively monitor a woman from the moment she has a fertilized egg inside her body. Again, a substantial infringement on the right to privacy.
These bills will not only harm women who need fertility treatments, who experience stillbirth or miscarriage, but even those who unknowingly carry out an activity during pregnancy, that is potentially harmful to a fertilized egg, embryo, or fetus.
These bills are dehumanizing, completely removing girls’ and women’s agency over their bodies, by forcing them to proceed with pregnancies in cases of rape, incest, and/or pedophilia.
Finally, being denied abortion access contributes to entrenched poverty and worse economic outcomes(Cubbin et al., 2002). And this is because, the ability to choose if, when, and how to give birth is linked to women’s economic success, educational attainment, and general health and well-being (Bahn, 2017).
How These Bans Will Negatively Impact Women’s Health and Wellbeing:
Limiting or removing access to safe abortions essentially repeals women’s access to comprehensive healthcare; particularly reproductive health services.
Bills that criminalize medical providers will have disastrous effects on the health and well-being of women, because physicians will likely be unwilling to help patients in need, even in cases where continuing pregnancy will be detrimental to a patient’s health or potentially fatal, out of fear of prosecution by the criminal justice system.
A 2013 report found that in 2008, women traveled a mean distance of 30 miles for abortion care services, with a median of 15 miles. While, six percent traveled more than 100 miles (Jones, et al, 2013) . And this reiterates the fact that abortion bans will most greatly burden under-resourced women who will not have the means to travel required distances for safe abortions.
Abortion can never be banned, access to safe and legal abortions is what will be banned; and this can result in premature and preventable death for many women. In fact, prior to Roe v. Wade, in 1965, illegal abortions made up one-sixth of all pregnancy-related deaths — and that’s just according to official reports; doctors think the actual number was a lot higher (Gold, 2003).
These bills are passed under the guise of wanting to preserve the “sanctity of life”, but offer no guaranteed socioeconomic support for the child following birth; leaving the complete burden on the woman, which may negatively impact her, and the child over their life courses (Gipson, Koenig, & Hindin, 2008).
It must be noted, particularly when it comes to the disproportionate and negative maternal health outcomes for Black women and other women of color, states passing strict abortion bans have some of the highest maternal and infant mortality rates in the country. According to 2017 data from the Centers for Disease Control on infant death rates and a 2018 USA Today investigation on maternal mortality rates in the 46 states with available data, nearly all of the states who have recently passed restrictive bans on abortion rank in the top 10 states for maternal mortality, infant mortality, or both. This goes against the proponents of these laws claim that they are trying to “uphold the sanctity of life”. And why it may be unclear the rate of increase these laws will have on maternal and infant mortality rates, increases in maternal mortality have been tied to other strict regulations on clinics, defunding of family planning programs, and other attempts to diminish Reproductive rights (Gipson et al., 2008).
In the case of an unintended pregnancy, the restrictions and barriers women face in pursuit of an abortion can result in stress and delay of critical prenatal care, further contributing to maternal mortality rates (Gipson et al., 2008).
Adoption is Not The Answer
Those who oppose abortion and uphold restrictive fetal heartbeat bills often point to adoption as a universal alternative, or even a “solution” to dealing with abortion.
The truth of the matter is that this is not the case, especially when having the choice and access to safe abortions, more women choose that option over carrying out a full-term pregnancy and putting up their newborn child for adoption. Recent statistics show that approximately 14,000 newborns are adopted annually in the United States through voluntary placements (Center for American Progress, 2010), a number that has remained flat for about 20 years. Meanwhile, in 2011, 1.06 million abortions were performed.
Also this argument ignores the fact that the child welfare system, across the United States, is underfunded and overburdened, which has dire consequences for system-involved children.
Removing abortion as a safe option and forcing women who are unprepared for motherhood, experiencing financial hardship (particularly in areas where social services are greatly underfunded and considering the cost of childcare and limited maternity leave in the U.S.), or simply have no desire to be mothers to carry out pregnancies to full term will only result in more children ending up in foster care and the child welfare system.
A Look Back: Accessing Abortions Before Roe v. Wade
Scholars have estimated that between 20% and 25% of all pregnancies ended in abortion before Roe v. Wade. Additionally, estimates of the number of illegal abortions in the 1950s and 1960s ranged from 200,000 to 1.2 million per year.
While the most stark indication of the prevalence of illegal abortion was the death toll. The following excerpt from the article, Special Analysis - Lesson from Before Roe: Will Past be Prologue? published by the Guttmacher Institute provides some insight about the prevalence and the most dire consequence of unsafe abortions:
One stark indication of the prevalence of illegal abortion was the death toll. In 1930, abortion was listed as the official cause of death for almost 2,700 women—nearly one-fifth (18%) of maternal deaths recorded in that year. The death toll had declined to just under 1,700 by 1940, and to just over 300 by 1950 (most likely because of the introduction of antibiotics in the 1940s, which permitted more effective treatment of the infections that frequently developed after illegal abortion). By 1965, the number of deaths due to illegal abortion had fallen to just under 200, but illegal abortion still accounted for 17% of all deaths attributed to pregnancy and childbirth that year. And these are just the number that were officially reported; the actual number was likely much higher.
Thus, one does not have to look that far back in the past to understand the importance of “safe & affordable” abortions. Prior to 1973, women in the United States risked their lives to terminate unwanted and untimely pregnancies. Many of these procedures were self-induced and included throwing oneself down a flight of stairs, ingesting poison or caustic materials, or introducing various instruments into the body. Women also turned to the unregulated market. This unregulated market included the Jane Collective, a group founded in 1969 in Chicago who provided abortions when the procedure was still illegal in much of the country. People seeking abortions could call a hotline and leave a message for “Jane,” and members of the collective would meet her, counsel her, and perform the procedure themselves at a secret apartment they called The Place.
There are many heart-wrenching photos of desperate young women who died as a result of undergoing “back street abortions”.
Excerpt From a January 1966, Washington Post four-part series on how women in the Washington area obtained abortions.
The most common abortion tool in Washington is a rubber catheter attached to a straightened wire coat hanger, according to Dr. John Skilling, chief obstetrical resident at Washington Hospital Center, “I had a 26-year-old girl here recently who did it that way herself lying on a bed with a mirror,” he says. “She didn’t have $300 for an abortionist and couldn‘t afford to lose her job as a keypunch operator.”
“There was so much pain — I can‘t explain it really,” another woman told a grand jury after an illegal operation was performed on her without anesthetic. “It was just like my whole stomach was coming out,” she testified.
“When a girl comes to our emergency room she’s bleeding massively,” Skilling says, “She has a high fever — and often an infection in the blood stream or abdominal cavity or a bowel obstruction.”One of Dr. Skilling’s recent patients had injected a soapy solution with a catheter and swallowed 30 tablets that she thought would make her womb contract. The price of aborting her four-month fetus was the loss of her womb — and later the loss of her hearing. The deafness was caused by the powerful drugs necessary to save her life during an 11-week illness that cost $14,000.
Dr. Benny Waxman, chief medical officer in D.C. General’s Department of Obstetrics, says about 10 percent of D.C. General’s obstetrical admissions are suffering from spontaneous or criminal abortions.
One recent patient was a 16-year-old girl who drank lye to abort herself and died. Another woman succumbed to gas gangrene — a toxin that can kill between 24 and 48 hours after a bungled abortion.
On D.C. General‘s grounds is a stark, square brick building which is the city’s morgue. Dr. Richard L. Whelton, the Coroner, says that he has seen only five abortion victims here in the last five years. One, he said, was the victim of a hospital nurse who brought surgical instruments home to “help out” her neighbor.
In 1965, the death list of Washington women included:
Jeretha Tanner, a mother of three, who died during an abortion attempted by Theodora Cagle, a 45-year-old practical nurse, police said.
Teresa Lyles, 26, who died of an air embolism after an abortion attempted, police said, by James L. Davis and Shirley J. Rawot.
A 26-year-old suburban Maryland housewife who died June 1 at George Washington University Hospital from an infected abortion performed, police charged, by Lucille Caroline Jefferson.
As we see the closure and underfunding of more and more family planning clinics that can provide safe abortions, will leave many women in the United States, especially women of color, and other under-resourced populations, facing the same dilemma that their foremothers had to cope with; and this includes having to “State Hop”, which is traveling to another state in order to have a safe abortion. Besides being a financial burden and barrier for many women, the act of state hopping is also coming under attack by some of the recent restrictive abortion bans, which seek to prosecute mothers who leave the state to seek safe abortions.
These restrictive abortion bans not only violate the fundamental human rights of women they also threaten their life, health and economic future. It is imperative that we take immediate action to curtail these restrictive abortion bans.
Center for American Progress (October 2010). Jason Arons.The Adoption Option Adoption Won’t Reduce Abortion but It Will Expand Women’s Choices. Available online at: https://cdn.americanprogress.org/wp-content/uploads/issues/2010/10/pdf/adoption_report.pdf
Centers for Disease Control. Infant Mortality Rates by State. Available online at: https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm
Cubbin, C., Braveman, P. A., Marchi, K. S., Chavez, G. F., Santelli, J. S., & Gilbert, B. J. C. (2002). Socioeconomic and Racial/Ethnic Disparities in Unintended Pregnancy Among Postpartum Women in California. Maternal and Child Health Journal, 6(4), 237–246. https://doi.org/10.1023/A:1021158016268
Gipson, J. D., Koenig, M. A., & Hindin, M. J. (2008). The Effects of Unintended Pregnancy on Infant, Child, and Parental Health: A Review of the Literature. Studies in Family Planning, 39(1), 18–38. https://doi.org/10.1111/j.1728-4465.2008.00148.x
Guttmacher Institute. Rachel Benson Gold. (March 1, 2003). Special Analysis - Lessons from Before Roe: Will Past be Prologue? Volume 6, Issue 1. Available online at: https://www.guttmacher.org/gpr/2003/03/lessons-roe-will-past-be-prologue
Henshaw, S. K. (2009). Unintended Pregnancy and Abortion in the USA: Epidemiology and Public Health Impact. In M. Paul, E. S. Lichtenberg, L. Borgatta, D. A. Grimes, P. G. Stubblefield, & M. D. Creinin (Eds.), Management of Unintended and Abnormal Pregnancy (pp. 24–35). https://doi.org/10.1002/9781444313031.ch3
Kate Bahn and others, “Linking Reproductive Health Care Access to Labor Market Opportunities for Women” (Washington: Center for American Progress, 2017), available at https://www.americanprogress.org/issues/women/reports/2017/11/21/442653/linking-reproductive-health-care-access-labor-market-opportunities-women/.
Leana Wen, (May 23, 2019). Statements on Unprecedented Attacks on Our Rights & Freedoms. Planned Parenthood Federation of American. Available online at: https://www.plannedparenthood.org/about-us/newsroom/press-releases/dr-wen-these-unprecedented-attacks-on-our-rights-and-freedoms-must-end
Rachel K. Jones and Jenna Jerman.Journal of Women's Health.Aug 2013 Volume 22, Issue print http://doi.org/10.1089/jwh.2013.4283
USA Today. Laura Ungar & Caroline Simon. Which states have the worst maternal morality? Available online at: https://www.usatoday.com/list/news/investigations/maternal-mortality-by-state/7b6a2a48-0b79-40c2-a44d-8111879a8336/?block=kentucky
Washington Post. (June 9, 2019). When abortion was illegal: A 1966 Post series revealed how women got them anyway. Available online at: https://www.washingtonpost.com/history/2019/06/09/when-abortion-was-illegal-post-series-revealed-how-women-got-them-anyway/?utm_term=.cd41b89b3c1e