The most recent omnibus abortion restrictions included four main provisions, three of which go into effect on October 29 of this year. Many Texas medical providers and reproductive choice organizations have filed a complaint and called for an injunction on two of those provisions, but one mandate will without question be implemented in a few weeks: The ban on abortions that are 20 weeks along or later.
This two-part series addresses the consequences of the 20-week ban on women's reproductive rights and why lawmakers and citizens must work to keep both elective and medically necessary abortion accessible for all women. You can read Part 1 here.
When Wendy Davis filibustered the abortion bill, some of the most heartbreaking narratives that she read were written by women who chose to abort planned, wanted pregnancies. Women who learn that something has gone wrong with their pregnancies deserve the time and resources necessary to make an informed choice. Unfortunately, the 20-week ban forces women to make life-changing decisions, sometimes only hours after learning of a fetal abnormality.
Read more about how the 20-week ban hurts both doctors and pregnant women who experience medical complications.For women who are privileged enough to receive consistent, quality medical care throughout their pregnancy, prenatal testing is usually scheduled around the 20th week of pregnancy. Amniocentesis, which tests amniotic fluid for fetal abnormalities and genetic problems, is sometimes performed as late as 22 weeks.
According to Amy Hagstrom Miller, founder, president, and CEO of Whole Woman's Health, those appointments sometimes conclude with a referral to a geneticist or a fetal medicine specialist.
The 20-week ban does include an exemption for women with life-threatening pregnancies or instances in which the fetus' condition will likely prevent it from living outside the womb.
However, the ambiguity of the bill's language puts both doctors and women at risk. It is up to doctors to make the judgment call on whether a fetus could be viable several months after the initial test is performed.
“My doctors are terrified,” said Miller. “They don't want to be hung out to dry because they defined something as a severe fetal anomaly, but the state says, 'That's not severe enough.'”
This dangerous uncertainty is just one example of the complications that arise when the state intervenes in a choice that should be between a woman and her doctor.
Most abortion practitioners must rely on the referring doctors to determine whether a woman could legally obtain an abortion by the state's vague definitions. Still, there are a wide range of health problems that a pregnant woman could encounter, from underdevelopment of fetal organs to congenital disorders to fluid in the brain. Accounting for factors like the woman's health history and future complications, it is almost impossible to accurately guess the likelihood of fetal survival in each of these cases.
Furthermore, survival rates depend on the woman's access to health care. According to Miller, “When they say, 'A fetus can live on its own at 24 weeks,' I always want to say, 'For a white woman in an urban area with really good insurance in a Trauma 1 hospital.'”
In the event that a fetus is diagnosed with a condition that would severely affect quality of life and is possibly but not definitively fatal, the pregnant woman would be subject to the 20-week ban.
For example, a woman who underwent an amniocentesis test during her 19th week could learn of a possible abnormality. If she had been able to afford a specialist appointment and schedule it soon after her prenatal test, she would have only one or two days to evaluate the medical information on the abnormality, consult with her physician and family, and make a decision on whether to keep the pregnancy. If she chose to abort the pregnancy, she would have to find a clinic with an open appointment, arrange travel, and find funding for the procedure. The procedure itself would take two days due to the 24-hour wait period after the required sonogram.
Women do not flippantly make the decision to have an abortion, particularly when the pregnancy is planned and wanted. But the 20-week ban denies women the time they need to cope with the situation.
Additionally, the restriction adds unnecessary pressure to women who encounter a health issue during their pregnancy. Women who develop cancer during a pregnancy are often forced to choose between lifesaving treatment and their pregnancy, a decision that requires time for medical consultations and contemplation.
The language of the law is also hostile toward women with severe, potentially fatal mental health issues: Regardless of the advice given by that woman's medical team, the law prevents her from seeking an abortion after 20 weeks.
By design, the 20-week ban is unsympathetic to pregnant women experiencing tragic medical conditions during their pregnancy: Conservatives in the legislature shot down the numerous attempts to add amendments that would exempt those women from the ban. By legislating decisions that should be made in a clinic, not the Capitol, Republicans have once again left women in need without options.