In states where abortion is illegal, some physicians are afraid to say the word; women struggle to get needed care

Lauren Miller traveled Colorado for medical care that is
now illegal in Texas. (Photo by Nitashia Johnson, NPR)

Hormone changes, nutritional deficits, and mental worry make pregnancy stressful for women and their bodies. When things go wrong, such as in the case of fetal fatality or an abnormality that prevents viability, women face an entirely new set of stressors. In some states, needed medical care may be illegal -- so illegal that physicians don't even want to say the word "abortion," reports Selena Simmons-Duffin of NPR.

The case of a woman in Dallas is an example of a state with tough abortion laws and no exceptions. "This past fall, when Lauren Miller was 13 weeks pregnant with twins, she got horrible news. One of the twins had trisomy 18, a genetic abnormality that causes about 90% of fetuses to die before birth. The other twin was healthy," Simmons-Duffin explains. "She learned from a genetic counselor that continuing to carry both fetuses could put the healthy one at risk. She saw a doctor who specializes in high-risk pregnancies who told her: 'You can't do anything in Texas and I can't tell you anything further in Texas, but you need to get out of state.'. . .That's exactly what she did. Miller traveled to Colorado and, at 15 weeks pregnant, she had a 'selective reduction' procedure to help ensure her pregnancy with her healthy twin could continue." In Miller's case, she was able to afford to go to another state, but many women do not have the means.

Once Miller had the procedure, she encountered another barrier. "When she returned and continued her prenatal care, she found herself navigating silence around abortion. She wondered if the ultrasound technician knew she'd traveled out of state for an abortion, could she get reported? Miller told Simmons-Duffin, "You don't know where anybody stands, so it feels like we're all kind of talking in code."

"What Miller did does not violate current abortion laws in Texas, legal experts say," Simmons-Duffin writes. "But the fear among doctors and patients in the new legal landscape in Texas is extreme, to the point where some doctors won't say the word 'abortion' in the exam room. Elizabeth Sepper, professor of law at the University of Texas, told Simmon-Duffin, "Physicians have independent speech rights, to speak to their patients openly," she says. "Physicians should not be scared to say the 'a-word.'" Simmons-Duffin adds, "Many doctors in Texas who treat pregnant patients are extremely scared. Especially of language in one of the state's abortion bans that allow people to take civil action against anyone who 'aids or abets' abortion." 

While some many states have abortion exceptions, the exceptions are rarely granted, reports Amy Schoenfeld Walker of The New York Times. "But in the months since the court’s decision, very few exceptions to these new abortion bans have been granted." In Kentucky, the only exception is threat to the woman's life; Alex Acquisto of the Lexington Herald-Leader wrote about two women who had to go out of state because Kentucky laws banning abortion "do not legally permit the standard-of-care treatment for a nonviable pregnancy."

Some think Texas physicians are over-reading that state's law. Amy O'Donnell of the Texas Alliance for Life, an anti-abortion rights group, told Simmons-Duffin that its attorneys "believe there is a constitutional right to interstate travel," but courts have yet to rule on the law and without precedent, it seems physicians will remain fearful. Dr. Andrea Palmer, an obstetrician-gynecologist in Fort Worth, told NPR, "People are scared to talk . . . The law's vague – it's really poorly written. . . . Nobody wants to be defendant number one on this."