Every Abortion Law in America Protects Women with Ectopic Pregnancies

S ince the Supreme Court’s Dobbs decision overturned Roe v. Wade, there has been a lot of viral misinformation spread on social media that women with ectopic pregnancies and other life-threatening conditions may not be able to be treated in states with laws limiting or banning abortion.

See, for example, this blatantly false and particularly shameful tweet from Daily Beast columnist Wajahat Ali:

In fact, no abortion law in any state in America prevents lifesaving treatment for women with ectopic pregnancies and other life-threatening conditions. That was true of abortion laws in 1972, and it’s true of abortion laws in 2022. “All states had at least a life of the mother exception before Roe v. Wade,” Clarke Forsythe, senior counsel at Americans United for Life, told me in an email. See, for example, the language in the Texas abortion statute struck down under Roe v. Wade in 1973 that said nothing in the law applies to an abortion performed “for the purpose of saving the life of the mother.” The other lie in Ali’s tweet is the idea that women undergoing abortions will be prosecuted. As Forsythe wrote in 2006, states prosecuted abortionists, not women, under pre-Roe laws.

Every state abortion law triggered by the overturning of Roe includes an exception at least to save the life of the mother, but that didn’t stop Senate majority leader Chuck Schumer from falsely claiming at a May 10 press conference (emphasis added): “If the MAGA Republicans get their way, pregnant women could lose their lives because there will be no exception for the life of a mother if there’s a dangerous complication in the pregnancy.”

The fearmongering about ectopic pregnancies is especially dishonest. Ectopic pregnancies, which account for one to two out of every 100 pregnancies, are pregnancies in which the embryo implants outside the uterus, and necessary lifesaving treatment for the mother results in the death of the embryo.

Many state laws, including the law in Texas, explicitly exclude treatment for ectopic pregnancies from the definition of abortion. On this matter, Planned Parenthood and anti-abortion Republican doctors agree.

Planned Parenthood’s official website states that treatment for ectopic pregnancies “isn’t the same thing as getting an abortion”:

Treating an ectopic pregnancy isn’t the same thing as getting an abortion. Abortion is a medical procedure that when done safely, ends a pregnancy that’s in your uterus. Ectopic pregnancies are unsafely outside of your uterus (usually in the fallopian tubes), and are removed with a medicine called methotrexate or through a laparoscopic surgical procedure. The medical procedures for abortions are not the same as the medical procedures for an ectopic pregnancy.

“I personally have treated hundreds of women with ectopic pregnancies,” pro-life Republican senator Roger Marshall, an obstetrician from Kansas, said in a Senate floor speech last month. Marshall noted that the “Catholic Church supports the treatment of ectopic pregnancies.”

So where did all the misinformation and fear about treatment of ectopic pregnancies come from? There are many sources, but one oft-cited story was published in the Lily in October 2021. The National Abortion Federation told the Lily it got a call from a woman with an ectopic pregnancy who was denied treatment by both her primary-care doctor and an emergency room due to Texas’s heartbeat abortion law effectively banning abortion later than six weeks of pregnancy. Is it likely that both a doctor and a hospital were ignorant of Texas’s law regarding ectopic pregnancy? The lone story is impossible to verify: The names of the alleged doctor, the hospital, and the woman in NAF’s tale remain unknown. But the Texas law has been on the books since September 2021, and if as many as one in 50 pregnancies is ectopic, many more stories would have come to light if there was genuine confusion about the legality of treating ectopic pregnancies.

One Texas-based abortionist sowed doubt in that same October 2021 story in the Lily about whether doctors could immediately treat ectopic pregnancies: “Normally most physicians want to intervene as soon as they diagnose an ectopic pregnancy, before it ruptures. . . . Do you have to wait until it’s about to rupture? Until it has?” But, again, Texas law explicitly excludes the treatment of ectopic pregnancies from its definition of abortion.

“No matter how an obstetrician feels about abortion, we all treat ectopic pregnancies the same way,” Dr. Ingrid Skop, a practicing obstetrician in San Antonio who also serves as senior fellow and director of medical affairs at the pro-life Charlotte Lozier Institute, told National Review in a phone interview. “We feel compelled to treat it as soon as possible. . . . There is no doubt in my mind as an obstetrician,” said Skop, that treatment should occur immediately and that such treatment is legal. In an ectopic pregnancy, an embryo “cannot make it to viability. We do not have the ability to move the pregnancy to a better location,” she said. “It is not controversial at all that this needs to be treated.”

What about other conditions that can threaten the mother’s life during pregnancy? While treatment of ectopic pregnancies is explicitly excluded from the definition of abortion in Texas law, Skop pointed to other life-threatening situations in pregnancy — such as some cases of severe hypertension or times when a pregnant mother has an infection that could lead to sepsis — when an unborn child must be delivered before viability to save the woman’s life.

Legally, such treatments would “fall under the life-of-the-mother exception” in Texas abortion law, Skop said. “As a pro-life physician who has practiced in Texas for 30 years, I have treated this situation many times,” she said. “The likelihood of a subclinical infection progressing to a clinical infection that can lead to sepsis is quite high.”

Paul Linton, a constitutional lawyer, told me in a phone interview that life-of-the-mother exceptions in abortion laws “do not have any requirement of imminency or immediacy” of a threat to the mother. In other words, a life-threatening infection could be treated as soon as it was detected.

“The likelihood that the baby is going to make it to a live birth and do well is extraordinarily low,” Skop said. “It’s very difficult to adequately treat that intrauterine infection with antibiotics only, without emptying the uterus.”

“This does not have to be a [dilation and evacuation] abortion” that “dismembers the baby,” said Skop, who has delivered more than 5,000 babies. “The caring, compassionate thing to do is to induce labor.” Ethically, pro-lifers draw a moral distinction between inducing delivery before viability to save the mother’s life and direct abortions. But, as far as the law is concerned, such inductions or abortions would be covered under the provision of Texas’s abortion statute that protects the life of the mother.

Despite the life-of-the-mother exception in all abortion laws, there is some confusion (some of it genuine, some of it spread in bad faith) about when lifesaving treatments are allowed.

See, for example, this viral tweet posted by actress Halle Berry:

Abortions performed to save the life of the mother make up a tiny percentage of all abortions. For example, last year in the state of Florida, 0.15 percent of all abortions were performed “due to a life endangering physical condition.”* But the confusion over when such abortions are allowed “is benefiting the abortion advocates because it’s turning the American public, for no good reason, against the laws because of course everyone is concerned that if a woman’s life is threatened by her pregnancy, that we take care of her,” Skop said.

She called on state medical boards, such as the Texas Medical Association, and government attorneys to join together in a “collaborative effort” to clear up such confusion. “If there’s a new law that has caused confusion in the medical community, as this law obviously has, it should be imperative for [medical boards and organizations] to seek out legal guidance on what the law actually says,” Skop told me. “They should be willing to educate their providers on what is permissible, and that is not being done.”

*Correction: The percentage of abortions performed in the state of Florida in 2021 to save the life of the mother was originally incorrectly reported in this article as 0.015 percent; the correct figure is 0.15 percent.