In the fall of 2015, Rachel Goldberg was pregnant with her first child. She and her husband, who live in rural Missouri, were ecstatic about the prospect of starting a family, and she recalls eagerly anticipating her routine 20-week ultrasound check-up. She was excited to find out the sex—male, she would later learn—and she was hoping to get some photos to show her family and friends.
But the appointment didn't go as expected; Rachel's doctor detected some abnormalities and recommended her to a specialist. During that check-up, which spanned a full, tense hour, she and her husband began to get the sense that something was seriously wrong. "They couldn't find his stomach," she tells Broadly over the phone, her voice soft and measured. "They were taking a lot of pictures of his heart." Her fetus had a severe form of skeletal dysplasia, a condition that causes abnormal bone development. She was told that the fetus was unlikely to survive the pregnancy and that, if born alive, would need multiple complicated surgeries. Even then, there was a chance her baby would die on the operating table.
The condition also put Rachel at risk, according to her doctor. In Missouri, abortion is illegal after 20 weeks, though there's an exception for cases where the mother's life is threatened. But an amniocentesis Rachel had taken came back inconclusive, which meant that her doctor couldn't definitively prove that denying her an abortion would seriously threaten her health. "Essentially, the diagnosis would have to be made after delivery, which seems a bit ridiculous if you think about it," she says darkly. "At that point, it's not very helpful."
By the time she had finished undergoing all the tests that were necessary to identify the fetus's condition, Rachel was a full 25 weeks into her pregnancy. She felt that abortion was her only option: She didn't want to risk leaving her husband both childless and widowed, and she didn't want her son's brief life to be filled with needless suffering, if he even lived at all. There are only four doctors in the US who will terminate a pregnancy that far along. The nearest one, Dr. Warren Hern, was in Boulder, Colorado—a 12-hour drive away. Rachel's insurance also refused to cover the procedure, which she says cost $10,000. So she and her husband took out a loan, and took a week off of work to make the several-hundred-mile journey. The procedure, which lasted four days, ended with a stillborn delivery.
Procedures like the one Rachel underwent are rare: Just one percent of abortions take place after 20 weeks. It's fairly obvious why this is. As Rachel puts it, "Who wants to pay $10,000 to have an abortion when you could get one for $500?" And why would you choose to remain pregnant for months if you didn't want to be? But although such procedures are relatively uncommon, they're hyper-visible in the abortion debate—a beloved subject for anti-abortion activists and lawmakers, who insist, with no actual scientific justification, that fetuses can feel pain at 20 weeks. There are currently 17 states that ban abortions at this point in the name of preventing the fetus from suffering; on Tuesday, the House of Representatives will vote on a bill that would extend this ban throughout the country.
"My living son owes his life to me being able to have an abortion. It's absurd that they would put women in this position."
The proposed legislation, which is grandiosely known as the "Pain-Capable Unborn Child Protection Act," would punish any doctor who performs an abortion after 20 weeks with up to five years in prison, though it makes narrow exceptions for cases of rape, incest, or threat to the mother's life. (In cases of rape, for instance, the woman has to have gotten counseling or medical treatment for the assault before she can get the abortion. Many women wouldn't be able to afford this, as the average cost for a rape exam is about $1000, though this doesn't seem to bother proponents of the bill.) The threat of a federal ban is not a new one; the House passed similar bills in 2013 and 2015. Like these last attempts, the current bill is unlikely to make it past the Senate, though Trump has sworn to sign it into law should it reach his desk.
Announcing the vote last week, House Majority Leader Kevin McCarthy declared that the guiding principle behind the federal 20-week ban was "ending suffering and helping people live." Pro-choice advocates disagree. "My living son owes his life to me being able to have an abortion," says Rachel. "It's absurd that they would put women in this position."
In general, advocates say putting a blanket ban on abortions after 20 weeks callously overlooks the fact that women who choose to do so are often in desperate or otherwise disadvantaged situations. Many serious fetal abnormalities can't be detected until that point, and women who choose to terminate later in pregnancy for non-medical reasons generally fall into at least one of five categories, according to a 2013 study: They're raising children alone, struggling with depression or using illicit substances, facing intimate partner violence at home, contending with a host of state-mandated obstacles to access, or they're young and have never been pregnant before, meaning they may not recognize the symptoms of pregnancy.
"I don't think anybody enters into this lightly," says Susan Ito, an Oakland-based writer who got an abortion at 24 weeks after developing a severe case of preeclampsia. "I feel like it was the hardest decision—it was the hardest situation I've ever been in." She chafes at the implication that women who terminate their pregnancies after 20 weeks aren't concerned with suffering or the value of life, or that the state has the right to make sweeping moral proclamations on behalf of the unborn with no regard for the complicated positions some pregnant women find themselves in. "I would have done anything to have a different outcome," she insists. "Who would willingly sign up for this?"
"There's hope: People can go on to have families if they want to. I found that really reassuring, and indeed, I did have children after that."
A federal ban would disproportionately affect young, low-income women, says Diana Greene Foster, a professor of obstetrics, gynecology, and reproductive sciences at Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, San Francisco, and the impact would be devastating. "Women who must carry unwanted pregnancies to term are more likely to live in poverty three years later than women who were able to receive an abortion," she tells Broadly. "Not being able to get a wanted abortion may also affect women's ability to care for the children they already have." According to extensive research conducted by ANSIRH, children are less likely to achieve developmental milestones and more likely to live in poverty when their mothers are denied abortion care. "Our research indicates that abortion enables women to take care of the children they already have and to plan a wanted pregnancy later," she says.
Susan Ito recalls sitting in her doctor's office in a follow-up appointment after her abortion. His wall was plastered with photos of babies, she remembers, which struck her. "He said, 'These are the babies that come after having to do the procedures that I do,'" she says. "There's hope: People can go on to have families if they want to. I found that really reassuring, and indeed, I did have children after that."
Rachel feels the same way. By denying her the right to an abortion, she says, lawmakers in her state were essentially gambling with her life and her family's wellbeing. She still thinks about what would happen if she hadn't been able to travel to Colorado: "I risk leaving my husband childless and having lost his wife on the same day, because somebody else's religious beliefs felt that this potential life was his to save, when essentially what he was doing was killing both of us," she says.