Many states’ abortion bans include rape exceptions. How often are they given?

After the Supreme Court struck down the federal right to abortion in 2022, many states that banned the procedure did so with the promise that it would still be legal in some cases, including in the case of rape. One study estimates He said that in states where abortion is banned, there have been more than 64,000 pregnancies due to rape in the years since the decision.

But many people on the front lines of the issue say it can be difficult, or in some cases impossible, to get an abortion after an assault in these states.

There is no central database measuring abortions due to rape. For this story, NPR reviewed state records and spoke with researchers, advocates and doctors in seven of 11 states where abortion is banned but legal in cases of rape. Taken together, these revelations illustrate a range of laws governing rape exemptions, confusion about who qualifies for exemptions and law enforcement’s role in the process, and widespread doctors’ fears about performing abortions for assault victims.

Many victims do not have the ability to immediately report their rape

It’s nearly impossible to know exactly how many abortions were performed because of rape exemptions. Doctors do not need to give a reason when reporting the procedure. It may also fall under a different exemption, such as abortion, fetal anomaly, or life of the mother.

Available annual data shows that in many states the number of known abortions performed for rape is in the single digits, and in some cases zero.

One reason is that in many states, rape victims seeking abortions are required to report their assault to law enforcement. Lawyers and medical professionals who work with rape victims say more pressing issues than abortion laws need to be considered after an assault.

“At this point, it’s just too much for them to handle,” says Katy Rasmussen, a nurse who works with assault victims with the Johnson County Sexual Assault Response team in Iowa. The patients he sees are often in shock or dealing with the stigma around sexual assault. If alcohol or illicit substances are involved, patients may feel embarrassed and even blame themselves, Rasmussen says.

“Survivors of sexual assault often just want it to end,” says Kelly Miller, former executive director of the Idaho Coalition Against Sexual and Domestic Violence. “And most survivors who have to go through the trauma of reporting, the trauma of the forensic interview, give up on all of that.”

Other advocates point out that many patients experience domestic violence when they are raped. That’s what happened to Laurie Betram Roberts. She says she became pregnant years ago after being raped by someone she lived with. She says reporting him and risking arrest could mean losing her home.

“We shared a house,” he says. “Because my family was so big, there wasn’t a domestic violence shelter to take me to.”

Bertram Roberts, who had seven children, eventually freed herself from this man. She now works with people in similar situations as part of her job at the Mississippi Reproductive Freedom Fund; This is a nonprofit organization that helps people get abortion care in this state.

“There is a perception of good and bad abortions” among people who support state abortion bans, says Bertram Roberts. “But the reality is that the exemptions are all rhetoric and have no practical use.”

There were zero abortions for any reason in Mississippi last year. a new report From the WeCount project of the Family Planning Association.

Mississippi Governor Tate Reeves has promised a rape exemption when the state’s 2022 law goes into effect. In addition to Reeves’ office, NPR also reached out to lawmakers in many states and national anti-abortion groups that sponsor these bans. Neither wanted to talk about nationwide rape exemptions.

A group called Susan B Anthony Pro-Life America sent a written statement to NPR blaming doctors and health systems for their confusion and failure to use the law. The statement said, “If there are doctors confused about rape exceptions, hospital administrations and healthcare associations need to clarify this issue.”

Some doctors say they feel armed and intimidated

In South Carolina, where doctors are required by law to report abortions for rape to the local sheriff’s office, the involvement of law enforcement makes patients and doctors feel like “potential criminals,” says obstetrician Jessica Tarleton.

“A person comes to the emergency room who has been shot, we don’t ask him what he did to get into the position of being shot. We take care of the patient,” says Tarleton. He points out that no other type of medication requires doctors to legally justify the care.

“I am aware that a patient with whom I had a relationship within the past two years sought a legal abortion under the rape exception.”

Tarleton tries to provide abortion care to the best of its ability legally. But she says many doctors in the state are afraid and feel they don’t have enough support to provide abortions in a place considered legally risky. As a result, he says, many people have moved away from the practice altogether.

‘I am the investigator now’

Iowa makes it especially difficult for rape victims to get abortions, according to doctors and reproductive rights advocates.

This summer, after a lengthy court battle, the state began enforcing a six-week abortion ban with exceptions for certain circumstances, such as rape. But directions From the Iowa Board of Medicine They say doctors should decide whether rape is justified before performing an abortion or risk legal consequences for not complying.

That’s an unusual level of detail for doctors to collect and document, even in the 10 other states that include rape exemptions.

Dr. works in Waverly, a town of 10,000 in northeastern Iowa. “I am now the investigator trying to decide whether the details of the incident constitute rape under Iowa Law,” says Emily Boevers. These requirements, he says, threaten the privacy, trust and confidentiality of the patient-doctor relationship. “I need to maintain a therapeutic, compassionate relationship with this patient while questioning all these details,” says Boevers.

He hasn’t had to explore the circumstances of the attack with a patient yet, but he’s been rehearsing what he’ll say when that day comes. “Unfortunately, our government obliges me to ask you some questions,” he plans to say. “If you can answer these, I can help you.”

Those who enforce the law may not always know the law

In some states, there is little clarity about rape exemptions, even among officials tasked with enforcing the laws.

Idaho prohibits abortion except in cases of rape, incest and when the mother’s life is threatened. To get an abortion, sexual assault victims must submit a police report to health officials.

When the state’s ban goes into effect in 2022, victim advocates were quick to point out that law enforcement does not release police reports until a case is closed, preventing victims from accessing timely care. The following year, the Idaho Legislature amended the text of the bill so that rape victims had the right to obtain a copy, if requested, within 72 hours of the report being made.

However, agencies appear to follow these requirements unevenly.

Boise State Public Radio reached out to 56 law enforcement agencies in Idaho about protocols for helping rape victims since the ban. A handful of people said they complied with the 72-hour change and that in-house victim advocates were prepared to help victims through the process.

Many people seemed unfamiliar with this change. Some public records departments have said they will automatically deny requests for a copy of a report on an open case, regardless of who prepared it. One agency found it did not comply with the 72-hour law after it came into force and unknowingly denied records to rape victims.

Local agencies said they had not received any guidance from the state.

Advocates say this murky process further complicates a reporting system already unwelcome to victims.

“Survivors often do not report into these systems that were never created to center survivors,” says Miller, former president of the Idaho Coalition Against Sexual and Domestic Violence. “You may only access these systems for the sole purpose of accessing abortion as a result of pregnancy resulting from sexual assault.”

State records show fewer than 10 abortions for any reason were performed in Idaho last year.

Rape exception abortion providers generally protected by large institutions

Only a handful of doctors interviewed for this story reported that they consistently perform rape-exception abortions. Those who did all of these worked at large academic medical institutions.

Dr. in Georgia Nisha Verma estimates that she sees someone who has been raped or experienced incest meeting the exception standard “every few weeks.”

Verma is not an official spokesman and asked not to be identified using his institution’s name. But he says his employer has protocols and work teams to help doctors manage their legal risks. This helps alleviate doctors’ fears of losing their medical license, being fined, or going to jail.

“At my institution, we have once again really worked to create a system to help physicians feel more supported and protected,” Verma says.

But for most people who work with victims, it’s not just a matter of how to obtain an abortion exemption. Some states, for example, are also plagued by a lack of providers willing to deliver babies, let alone perform legally risky procedures.

“The question is,” says Bertram Roberts of the Mississippi Fund for Reproductive Freedom, “who will perform your abortion if you have a waiver in Mississippi?” of the state significant deficiency from gynecologists.

Bertram Roberts says he has never met anyone in this state who has received an exemption for any reason, let alone rape.

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