As state legislatures continue to advance abortion bans and restrictions, public debates among anti-abortion politicians have centered around how far to go in restricting access to care—how far is too far? These disagreements ignore a critical truth: every ban on abortion care is extreme. Whether a line is placed at six weeks, twelve, or twenty, preventing people from exercising their right to bodily autonomy is an inexcusable injustice. The narrative of a “middle ground” on abortion bans—whether through compromising on a gestational limit or allowing exceptions to the ban—serves only to further marginalize communities most impacted by attacks on abortion access.
The Harm of Abortion Bans
Since the Dobbs decision eliminated the federal right to abortion care, the already fragmented state of abortion access that existed under Roe has been decimated. Fourteen states have outright banned abortion care in nearly all circumstances (see Map 1). The abortion deserts these bans create in the South and Midwest force patients to travel hundreds of miles—if they can afford to do so, paying not only for care but for additional costs including transportation, child care, and lost wages. Some may order abortion pills outside of the formal health care system to self manage their care, but medication abortion care is not an option for everyone, and self-managed care brings with it serious legal risk—especially for pregnant people of color, who are already over-policed and over-criminalized. Even in states where self-managed abortion is not illegal, people are being criminally investigated or arrested for managing their own abortion or helping someone else to do so.
The facts are clear on what happens to people who are unable to access abortion care: the negative outcomes for finances, health, and emotional wellbeing are well documented. It is also clear who is least likely to be able to overcome barriers to abortion access: people living on low incomes, Black, Indigenous, and other people of color, young people, immigrants, and people with disabilities. Of the over 36 million women of reproductive age living in states that have banned abortion, more than 15 million are women of color, nearly 3 million have disabilities, and over 12 million are economically insecure. Beyond these estimates, transgender and gender-nonconforming individuals face additional barriers to receiving reproductive health care, including abortion. This catastrophic loss of abortion access only threatens to worsen the existing maternal health crisis—particularly for the Black women and pregnant people who are most at risk of pregnancy-related morbidity and mortality.
What is less clear is why, barely a year into this post-Roe landscape, the media has allowed the goalposts to shift on what is an acceptable compromise—what is considered “moderate.”
These markers of pregnancy that are used to regulate abortion are not based in science, but rather in politics: the regulation of pregnancy by trimesters comes itself from the decision in Roe v. Wade. In reality, every pregnancy, and every abortion patient’s situation, is different. The decisions of people seeking abortion and the ability of clinicians to provide care should not be decided by politicians—and should not be compromised. Although politicians such as Governor Ron Desantis in Florida are proposing near-total bans to appeal to the anti-abortion voting base, other arbitrary limits on abortion care should not be seen as palatable in comparison.
Take Senator Lindsey Graham, for instance, who introduced a federal fifteen-week ban last year, emboldened by Dobbs to go further than his previously proposed twenty-week ban. Oft-cited statistics demonstrating how later-abortion patients represent only a small portion of abortion patients overall (around 1 percent) are often used to justify bans later in pregnancy. But this position ignores the many reasons why patients seek care later. The fact is that no patient’s ability to access health care should be sacrificed for the sake of a political compromise.
There are a number of reasons why people seek abortion care later on in pregnancy. Many patients recognize the pregnancy later, particularly those who have never before been pregnant or who are using contraception. Other patients may have to delay care because of difficulty raising funds. Patients often need to pay for abortion care entirely out-of-pocket due to the discriminatory restrictions on abortion coverage, and as gestation increases, so does the cost for care. Although abortion funds do what they can to fill the gap, they cannot cover the cost of care for every patient. Some patients, too, may seek care later in pregnancy due to diagnoses of maternal or fetal health issues. Crucially, barriers to abortion access, and the logistical hurdles they create, contribute to more patients seeking care later—a crisis further exacerbated in the post-Dobbs landscape.
Exceptions Are a Distraction, Not a Solution
Often, in political discussions weighing limits on abortion care, exceptions to abortion bans are suggested as a mitigating factor. Most abortion bans being enforced include exceptions carved out for circumstances including the life (or sometimes health) of the pregnant person and in some cases for severe fetal anomalies. Less often, bans include exceptions for cases of rape or incest, though these require the pregnant person navigate additional—and potentially prohibitive—hurdles such as forcing survivors to report assault to law enforcement.
In practice, qualifying for these exceptions is like threading a needle in the dark: even abortion care that should be allowable under exceptions is incredibly difficult for patients to access in states with bans and restricted care. Even in cases of medical emergencies, patients in banned states are being denied life-saving care. Rather than improving care, focusing on exceptions serves as a distraction from the true harm of abortion bans and restrictions. The overwhelming majority of abortion seekers do not fall into the narrow categories of these exceptions, and that does not make them less deserving of care. Deeming certain patients, and certain abortions, more acceptable than others only perpetuates stigma and runs counter to the goal of abortion justice and equitable access to care.
If the true goal is equitable access to abortion, and ultimately, reproductive freedom, then it is necessary to understand the harms of all abortion bans. Agreeing on an acceptable ban on abortion, and allowing it to shift earlier and earlier in pregnancy, plays directly into the hands of the anti-abortion movement, and sacrifices the patients facing the most barriers and the greatest oppressions—and that is a compromise that should not be on the table.