Many state abortion bans include rape exceptions. How often are they awarded?

After the Supreme Court struck down federal abortion rights in 2022, many states that banned the procedure did so with the promise that it would still be legal in certain circumstances, including rape. One research estimates that in the years since the ruling, more than 64,000 pregnancies have occurred as a result of rape in states where abortion is banned.

But many on the front lines of the issue say abortion is difficult or, in some cases, impossible in these states.

There is no central database that measures the number of abortions due to rape. For this story, NPR reviewed state records and spoke to researchers, attorneys and doctors in seven of the 11 states where abortion is banned but legal in cases of rape. Taken together, these accounts reveal a patchwork of laws governing rape exemptions, confusion over who qualifies for an exemption and the role of law enforcement in the process, and a widespread fear among doctors about performing abortions on assault victims.

Many victims are unable to report their rape immediately

It is impossible to know exactly how many abortions are performed because of rape exemptions. When reporting a procedure, doctors are not obliged to provide a reason. And abortion may fall under another exception – fetal or maternal anomalies, for example.

Existing annual data suggests that in many states the number of known abortions performed as a result of rape is in the single digits or, in some cases, zero.

One reason is that in many states, rape victims who want an abortion are required to report the assault to law enforcement. Advocates and doctors who work with rape victims say there are more pressing issues to consider in the wake of the attack than abortion laws.

“It’s just too much for them at this point,” says Katy Rasmussen, a nurse who works with assault survivors on the Johnson County Sexual Assault Response Team in Iowa. The patients she sees are often in shock or struggling with the stigma associated with sexual assault. Rasmussen says that when alcohol or illegal substances are involved, patients may feel ashamed or even blame themselves.

“Often, survivors of sexual violence just want it to be over,” says Kelly Miller, former executive director of the Idaho Coalition Against Sexual and Domestic Violence. “So having to go through the trauma of reporting, the trauma of a court hearing, most survivors give up on it all.”

Other advocates point out that many patients experience domestic violence as a result of rape. This is what happened to Laura Betram Roberts. She says she became pregnant years ago after being raped by someone she lived with. In her opinion, reporting him and risking arrest could mean losing her apartment.

“We lived together,” he says. “There was no domestic violence shelter that would take me because my family was too big.”

Bertram Roberts, who has seven children, finally untangled herself from this man. She currently works with people in similar situations through her work at the Mississippi Reproductive Freedom Fund, a nonprofit that helps people gain access to abortions in the state.

“There is a belief among those defending state abortion bans that abortions are good and bad,” says Bertram Roberts. “But the truth is that all exceptions are rhetorical and have no practical application.”

According to them, there were no abortions for any reason in Mississippi last year recent report from the Family Planning Society’s WeCount project.

Mississippi Gov. Tate Reeves has promised rape exemptions when the state’s 2022 law goes into effect. NPR reached out to Reeves’ office, as well as lawmakers in many states who sponsored these bans and national anti-abortion groups. None of them wanted to comment on rape exemptions across the country.

One group, Susan B. Anthony Pro-Life America, sent a written statement to NPR blaming doctors and health care systems for the confusion and inability to use the law. “If some physicians have concerns about rape exceptions, hospital administrators and health associations should provide clarity,” the statement said.

Some doctors say they feel armed and intimidated

Law enforcement involvement makes patients and doctors feel like “potential criminals,” says Jessica Tarleton, an obstetrician in South Carolina, where by law doctors must report abortions resulting from rape to the local sheriff’s office.

“Someone comes into the emergency room and has been shot. We don’t ask him what he did to get into a situation where he could be shot. We care about the patient,” Tarleton says. He points out that no other type of medicine requires doctors to legally justify their care.

“Over the last two years,” she says, “I know of one patient I was associated with who sought a legal abortion under the rape exception.”

Tarleton strives to offer abortion care whenever it is legal to do so. But he says many doctors in the state are terrified and believe they don’t have enough support to perform abortions in a place where it seems legally risky. As a result, he says, many people distance themselves from the practice altogether.

“Now I’m an Investigator”

According to doctors and reproductive rights advocates in Iowa, rape victims have a particularly difficult time getting an abortion.

This summer, after a lengthy court battle, the state began enforcing a six-week abortion ban that makes an exception for certain cases such as rape. But tips from the Iowa Medical Board they say that doctors – before performing an abortion – must determine whether rape is legal, otherwise they may face legal consequences if they do not follow the law.

That’s an extraordinary level of detail for doctors to collect and document, even among the other 10 states that include rape exceptions.

“Now I’m the investigator, trying to decide whether the details of the incident constitute rape under the Iowa Code,” says Dr. Emily Boevers, who works in Waverly, a city of 10,000 in northeast Iowa. In her opinion, these requirements threaten privacy, trust and intimacy in the patient-doctor relationship. “I am to maintain a therapeutic and caring relationship with this patient, checking all the details,” Boevers says.

She hasn’t had to investigate the circumstances of an attack on a patient yet, but she’s practicing what she’ll say when that day comes. “Unfortunately, our government is ordering me to ask you some questions,” he plans to say. “If you can answer these questions, I may be able to help you.”

Those who enforce the law may not always know it

In some states, there is confusion about rape exemptions, even among law enforcement officials.

Idaho bans abortion except in cases of rape, incest and threats to the life of the mother. To obtain an abortion, survivors of sexual assault must submit a police report to medical providers.

When the state’s ban went 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 changed the text of the bill to give rape victims the right to receive a copy upon request within 72 hours of the report.

However, agencies appear to be uneven in their compliance with these requirements.

Boise State Public Radio contacted 56 law enforcement agencies across Idaho about protocols to help rape victims since the ban was implemented. A handful said they complied with the 72-hour fix and said their internal victim advocates were available to help victims throughout the process.

Many other people seemed unfamiliar with this fix. Several public records departments said they automatically deny requests for copies of an open case report, regardless of who prepared it. One agency realized that it had failed to comply with the 72-hour law after it went into effect and unknowingly refused to provide documents to rape victims.

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

Advocates say this opaque process exacerbates a reporting system that is already unfriendly to victims.

“Survivors generally don’t report to systems that were never designed with survivors in mind,” says Miller, former head of the Idaho Coalition to End Sexual and Domestic Violence. “It is simply unrealistic to expect survivors to access these systems for the sole purpose of accessing an abortion following a pregnancy caused by sexual assault.”

State data shows fewer than 10 abortions occurred for any reason in Idaho last year.

Providers of non-rape abortions are often protected by large institutions

Only a handful of doctors interviewed for this story reported consistently performing abortions under the rape exception. All those who did so worked at major academic medical institutions.

Dr. Nisha Verma from Georgia estimates that “every few weeks” he meets someone who has been raped or experienced incest and meets the exception.

Verma is not an official spokesperson and did not want to be identified by her institution’s name. But she says her employer has protocols and task forces to help doctors manage legal risks. This helps alleviate physicians’ fears of losing their medical license, being fined, or facing jail time.

“At my institution, we have been working again to create a system that helps us as physicians feel more supported and protected,” Verma says.

For most people working with survivors, however, it is not simply a matter of obtaining abortion relief. For example, some states are also limited by a shortage of providers willing to even deliver babies, let alone perform legally risky procedures.

“The question is,” says Bertram Roberts of the Mississippi Reproductive Freedom Fund, “if you get a waiver in Mississippi, who will perform your abortion?” The state has significant shortage obstetricians.

Bertram Roberts says she’s never seen anyone in this state get parole for any reason, let alone rape.

Copyright 2024 NPR