A year before the Supreme Court overturned Roe v. Wade in 2022, Texas implemented Senate Bill 8, which banned abortions for all but the very few who made it to a clinic within about two weeks of missing their period. I was an abortion provider at the time in San Antonio, and the eight months I worked after SB8 took effect were the most depressing of my career. I was forced to turn away hundreds of patients and explain that the most convenient abortion clinic was more than 500 miles away in New Mexico.
The most difficult conversations I had during that time were with patients who had been raped. I remember a young woman in my clinic who, after learning that she couldn’t get an abortion because she was 10 weeks pregnant, told me she needed to rush back to work so her abusive boyfriend wouldn’t find out she had made an appointment at Planned Parenthood. She was pregnant because he had raped her, and she had hoped to get an abortion secretly, knowing that the bleeding and cramping that happen after a medication abortion are basically indistinguishable from having a miscarriage or a heavy period.
But that was no longer an option for her. I told her about the new state law, and that she’d need to leave Texas to get an abortion. Given her circumstances, I knew the suggestion was absurd.
Abortion bans are politically controversial, and many of the politicians who push them have used so-called “rape exceptions” as cover. Though Texas, like most states with a total abortion ban, doesn’t even pretend to offer an option for rape survivors to obtain abortions, five abortion-ban states — Idaho, Indiana, Mississippi, North Dakota, and West Virginia — have passed rape exceptions. But for rape survivors in those states, these exceptions are meaningless.
To obtain an abortion, survivors of rape are told they first must report the crime to law enforcement. Yet the vast majority of survivors never report being raped — because doing so would put them at greater risk of violence from their abuser, because they don’t trust the police, or because rape is so stigmatized they don’t feel comfortable discussing it.
Even if, hypothetically, a rape survivor files a police report and cooperates with investigators, they are now faced with the fact that there may be no providers willing to take the enormous legal risk of providing an abortion in an intensely hostile political environment. Instead, even in states like Idaho with a rape exception on the books, survivors of rape are being told they must leave the state to obtain care. I know this because I am seeing them in my clinic in Montana.
Pregnancies that result from rape are common. My research colleagues and I recently estimated that more than 64,000 girls and women got pregnant as a result of rape in the 14 states with total abortion bans while those bans were in place, through the end of 2023. More than half a million girls and women of reproductive age were raped during that time period.
A frequent reaction to our research is that our estimates simply can’t be correct — we must have put a decimal point in the wrong spot. But for colleagues who work with survivors of domestic violence, the numbers just confirm what they see every day: sexual violence is horribly common. According to the National Intimate Partner and Sexual Violence Survey, more than 3.4 million women report having become pregnant as a result of rape during their lifetime. And contrary to conventional wisdom, most incidents of rape are perpetrated not by strangers but by current or former intimate partners or family members. In this survey, 49% of rape survivors were 17 or younger when they experienced their first assault.
I talked with a woman who told me she had recently helped her 16-year-old granddaughter get an abortion after she was raped by a classmate. They live in a state where abortion remains legal; but thousands of other young survivors do not. She was horrified imagining what her granddaughter would have had to go through to get an abortion if they lived in a state that had banned abortions.
Like many Republican politicians, Texas governor Greg Abbott says he wants to support survivors of rape. Unfortunately for him, and for the people of Texas, abortion bans do the opposite, and no fake “rape exception” is going to change that. Banning health care has consequences, and survivors of sexual violence are paying too high a price.
Samuel Dickman, M.D., is the chief medical officer at Planned Parenthood of Montana.