After two years of tracking anything and everything happening with abortion rights in a daily newsletter, I’ve outlined the most important, urgent, and useful information in my new book: Abortion: Our Bodies, Their Lies and the Truths we Use to Win. In a moment when anti-abortion legislators and activists are launching attack after attack, my objective became to provide order to the chaos, and to cut through conservative misinformation and lies to reveal what their real endgame is for American women.
There’s perhaps is no better example of those lies than abortion ban “exceptions.” Before reading this excerpt, though, please know this: While exceptions were deliberately crafted in ways to discourage their use, it doesn’t mean you shouldn’t try. There are organizations in every state dedicated to ensuring that you can get the care you need; they can help you navigate the policies in your state and direct you to the best places for support. You can find some of those groups linked here.
And remember: The relentless attacks on our rights and freedoms aren’t just meant to turn back the clock for women, but to exhaust us into inaction. Anti-abortion politicians want us to be so overwhelmed reading story after story about raped children denied care, or women going septic, that we won’t notice what they’re doing behind the scenes. My hope is that Abortion will help with that overwhelm — arming readers with the information, language and context they need to fight back.
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Mississippi has an abortion ban exception for rape victims. At least, it’s supposed to. But in 2022, when investigative reporters from Mississippi Today went looking for a doctor who would provide a rape or incest victim with an abortion, they couldn’t find one. Not a single doctor in the state was willing to end the pregnancy of a sexual violence victim. And that’s the truth of “exceptions” in a nutshell; they exist only on paper. To put it simply: they’re not real.
In Louisiana, a woman was denied an abortion despite the fact that her fetus was diagnosed with anencephaly, a fatal condition specifically named in the state’s list of “exceptions.” And even though Texas’s ban allows abortions if someone’s life is endangered or if there would be a “substantial impairment of major bodily function,” Amanda Zurawski wasn’t given an abortion until she was in the ICU with sepsis. Another Texas woman, a twenty-five-year-old whose doomed pregnancy was making her increasingly ill, was told by doctors she’d need to have a stroke before she could come back for an abortion. And these are just the stories we know about.
None of these nightmares was an accident. Abortion ban “exceptions” are deliberately crafted to be impossible to use. In fact, the only reason they exist at all is to make Republicans seem a little less punishing. As the Guttmacher Institute’s Elizabeth Nash says, “Exceptions function mainly as PR tools to make abortion bans seem less cruel than they are and [to] distract from the inhumanity of the ban itself.
The truth is that when Republicans sit down to write “exceptions,” they do so with the sole intent of excluding as many people as possible.
Rape and Incest ‘Exceptions’
What’s one of the best-known facts about sexual assault survivors? That they overwhelmingly don’t report their attacks to law enforcement. The shame, fear of victim-blaming, and trepidation over the criminal justice system keeps more than two out of three victims from going to police.
So when Republican legislators write a law that’s supposed to help these victims get care, what do they do? They include a requirement that the attacks must be reported to law enforcement. That’s what I mean when I say lawmakers are carefully crafting these laws to never be used.
We also know that it often takes rape and incest victims time to come to terms with their attack; trauma isn’t processed overnight. It’s common for those who’ve been attacked to be in denial about a rape-related pregnancy; this is especially true when victims are younger or have been assaulted by a family member. So, Republicans add in a time limitation for rape victims to get care.
In some states, GOP legislators have written “exceptions” that purposefully terrify sexual violence victims. Before a South Carolina doctor can perform an abortion on a rape victim — assuming you can find a doctor willing to perform an abortion at all — they have to inform the patient that their name, information, and the details of their allegation will be reported to the local sheriff.
Leaving aside for a moment that outrageous breach in confidentiality, this is a clear way to scare rape victims away from having abortions. The law forces victims to go to the police regardless of whether they want to, and it contains an implied threat. Telling victims they’ll be reported to police gives the impression that if they’re not believed about their attack, they’ll be punished. It’s bullying.
Some Republicans are eager to make that threat of punishment even more explicit. Tennessee doesn’t have an abortion ban “exception” for rape victims, but when Republicans were briefly considering one, it included this telling mandate: any woman who the state believed made a false report would be guilty of a felony and would have to serve a minimum of three years in prison.
To put it plainly, anti-abortion legislators are relying on American victim-blaming to ensure that victims can’t get care. Iowa’s state medical board guidelines require doctors who are considering giving a victim an abortion to determine whether the attack is “prosecutable.”
And these are just the laws that apply to adults. The week that I sat down to write this chapter, Tennessee Republicans voted to force children twelve and under to carry pregnancies to term after being raped. Every single House Republican voted down an “exception” that would have allowed raped children to get care.
Anti-abortion lawmakers and activists also claim that pregnancy after rape is rare — a claim designed to hide their utter cruelty, and to pivot when asked about abortion ban exceptions. Some even say that women can’t get pregnant from a rape at all. Students for Life president Kristan Hawkins — who has been celebrated as the future of the anti-abortion movement — says that “sexual assault actually helps prevent a lot of pregnancies itself because of your body’s natural response.”
There’s a reason that conservatives consistently downplay how many women and girls are raped: they know that Americans very much oppose sexual violence victims being forced into childbirth. Anti-abortion lawmakers and activists believe that if they pretend that rape-related pregnancy — or rape in general — is rare, they can hide their extremism.
But a 2024 study estimated that there were 65,000 rape-related pregnancies in the fourteen states that banned abortion after Dobbs. Sixty-five thousand. The researchers used data from the CDC, the Bureau of Justice Statistics, and FBI Uniform Crime Reports to come up with their estimate.
One of the study’s authors, Dr. Samuel Dickman, told NPR he was “horrified” seeing the numbers. “Sexual assault is incredibly common — I knew that in a general sense. But to be confronted with these estimates that are so high in states where there’s no meaningful abortion access? It’s hard to comprehend.”
‘Exceptions’ for Nonviable Pregnancies
One of the more brutal Republican policies are so-called exceptions for fatal fetal anomalies — conditions that will result in a fetus dying in utero or after birth.
Since Dobbs, anti-abortion groups and lawmakers have launched a quiet campaign to do away with any exceptions for fatal fetal conditions and to pressure women in states with exceptions to carry their nonviable pregnancies to term, regardless of the law.
Republicans have to be sly about this particular initiative. They know that Americans are furious over stories like Kate Cox’s, the Texas woman denied an abortion despite a life-threatening pregnancy.
Cox’s story went internationally viral in 2023 after she was unable to get an abortion in her home state, even though she was diagnosed with a dangerous and nonviable pregnancy. With the help of the Center for Reproductive Rights, Cox filed for an emergency order asking for an abortion, a plea to prevent her baby’s suffering and to end her own.
In a just world, it would be unthinkable for a woman to have to beg the courts for such a thing. But Cox doesn’t live in a just world — she lives in Texas. And so she and her lawyers hoped that her obviously dire circumstances would clear the way for her to get care.
Instead, the state fought Cox’s request: lawyers for Texas claimed her life wasn’t sufficiently at risk, arguing that “countless women . . . give birth every day with similar medical histories.” As if this nightmare pregnancy was just business per usual. The state didn’t even bother to address the fact that the pregnancy was nonviable, because Texas doesn’t have an exception for fatal fetal conditions.
Still, a sympathetic judge — who got emotional during her ruling — granted Cox’s request. She called what the law was doing to Cox a “genuine miscarriage of justice.” That ruling didn’t stand for long, though. Texas attorney general Ken Paxton soon sprang into action, asking the state supreme court to reverse the judge’s decision. All to prevent one single woman from getting care.
Paxton was so intent on forcing Cox to carry this pregnancy, in fact, that he sent letters to three hospitals in Houston, threatening them with criminal charges if they provided or assisted in giving her an abortion.
Cox’s story sparked fury across the country. Americans saw, firsthand, exactly what anti-abortion politicians wanted for them and their families.
Republican legislators tried to run from questions about Cox — in one case, literally. When a reporter attempted to ask Senator Ted Cruz what he thought about Cox’s experience, the senator took off in a sprint. Nikki Haley said she believed the Texas law should be changed, but neglected to mention that she supported a national ban that would do to all American women what Texas did to Cox. One after another, Republicans showed their true colors.
In the end, so did Texas. The state supreme court ultimately sided with Paxton, reversing the judge’s order and blocking Cox from getting an abortion in her home state. And so the thirty-one-year-old mother of two did what most people in her situation would do if they had the ability — she left Texas to get the care she needed.
In addition to trying to do away with exceptions for nonviable pregnancies altogether, Republican legislators make those “exceptions” impossible to use. One of the GOP’s tactics is to claim that excep-tions exists for nonviable pregnancies, while narrowly defining what constitutes a nonviable pregnancy so that virtually no one can qualify.
North Carolina’s abortion ban, for one, requires severe fetal abnormalities to be “uniformly diagnosable” — an impossible black- and-white standard that applies only to a small handful of nonviable conditions. Other states define a nonviable pregnancy as one in which a newborn would die immediately upon birth or “imminently” thereafter. That language is vague enough that legislators can argue that a newborn who would live only for a few days doesn’t have a “fatal” condition.
Then there are the states that deliberately include no language at all about what constitutes a fatal diagnosis. The point here is to put doctors in the position of having to decide if they’re willing to risk their license and freedom on the chance that a fetus isn’t viable — and that a court of law would agree with that diagnosis.
What this means in reality is truly shocking: Parents forced to “prove” that a baby born without a skull is, in fact, going to die. Mothers wondering if their daughter’s condition constitutes being “lethal” because she’ll survive a few days rather than a few hours. People who might otherwise be able to grieve and recover at home in peace being forced to make their cases with lawyers in courtrooms. How is any of this “pro-life”?
What’s most shocking about these “exceptions” is that they allow conservatives to pretend as if they’re generously allowing vulnerable women abortions, even as they force them to beg for care. Cultivating that illusion of empathy is central to everything the GOP does when it comes to abortion.
That’s why Republicans frame their “exceptions” as policies that help and protect women. Anti-abortion states increasingly require that women with nonviable pregnancies be given resources about what the law calls “prenatal counseling” and “perinatal hospice care.” This sounds innocuous enough, but those terms are code for something much more insidious: anti-abortion groups posing as counselors and experts.
Dr. Robin Pierucci, who works with the “prenatal counseling” group Be Not Afraid, says, “I love reminding them that the first diagnosis is ‘It’s a baby,’ and no other diagnosis ever negates diagnosis number one. The baby is inherently valuable and worthy of our love.” Imagine getting perhaps the worst news of your life — finding out that your pregnancy isn’t viable — and having a cheerful doctor come into the room and say “congratulations.” Now imagine that women weren’t just directed to people and groups like this — they were required to be “counseled” by them. That’s what anti-abortion organizations and lawmakers are working on right now.
Health and Life ‘Exceptions’
Even if rape victims or patients with nonviable pregnancies can’t get abortions, surely Republicans would want those whose health or lives are endangered to be able to get care. Surely? Not even close.
Every woman who has come forward with a painful story of being denied care has lived in a state that claims to make allowances for women’s health; but when push comes to shove, they’re unable to get care. They’re not sick enough, or not close enough to death. Doctors around the country find themselves in the position of weighing their medical license and their freedom — against whether or not they should provide an abortion at that moment, or wait until their patient is just a little bit sicker.
If you were risking years in prison — decades, even — what would you choose?
There’s perhaps no better example of the failure of health and life exceptions than Tennessee. When Roe was first overturned, the state didn’t even have an allowance for women’s lives. Instead, the state had an affirmative defense mandate: a law that required doctors giving life-saving abortions to break the law and then later prove it was necessary.
In 2022 a Tennessee woman with an ectopic pregnancy had to wait hours while lawyers at the hospital put together a legal justification for her treatment. Ectopic pregnancies are nonviable and deadly for the pregnant person. But because of Tennessee’s law, doctors had to stop and prepare a legal defense before giving her care.
As the woman described to the Nashville Scene, she, her husband, and other family members spent those hours trying to find hospitals in another state in case she was refused. In the end, the doctors treated her, but they had to break the law in order to do so: “It’s a felony, what they did, and that is crazy to me. So while I’m recovering from surgery, and trying to emotionally process all of it, another layer of it was, what if my case wasn’t severe enough, right? And what if a prosecutor decides, ‘Well, we want to make an example.’ Like, what if I wasn’t bleeding internally enough?”
Maternal-fetal medicine specialist Dr. Sarah Osmundson wrote, in an op-ed in The New York Times, that the law was “intended to be ambiguous and confusing, to make physicians scared to provide abortion care.” She sits on the abortion committee at Vanderbilt University Medical Center — the group of ob-gyns and maternal-fetal medicine specialists who decide whether a patient is close enough to death to warrant care. She told Pro- Publica reporter Kavitha Surana how the committee members send each other urgent text messages, at all hours, to sign off on emergency life-saving care.
She recounted cases where the committee had to deny women care despite serious illness, like a patient whose pregnancy complications meant she could end up with an ostomy bag or sepsis. The issue was that the woman wasn’t in immediate danger. If she was given an abortion, a conservative prosecutor could later decide that the patient hadn’t really needed it and that doctors were guilty of a felony.
This is just one state, and the politics of just under two years. The same thing is happening everywhere. When Idaho Republicans wrote language to “clarify” the state’s abortion ban, they declined to include an exception for “life-threatening conditions.” Why? Repub- lican state representative Julianne Young said, “The list was endless when we began considering the decisions that would fall under that language.”
That’s right, when faced with the fact that there are an “endless” number of things that can go wrong during pregnancy and put someone’s life at risk — conservative lawmakers simply opted to leave out any allowance for them at all.
Why Bother?
If the point is to ensure that patients can’t use abortion ban exceptions, why include them at all? The truth is that when it comes to abortion rights, Republicans are desperate. The GOP has been struggling with how to talk about abortion at all, and conservative strategists think “exceptions” are the answer. Because the only thing more popular than broad access to abortion rights is abortion for sexual violence victims and those whose health and lives are in danger. The polling is astronomical, even in red states, and even among Republican voters. By focusing on exceptions, Republican legislators would finally have an abortion stance that’s popular. (That’s why Donald Trump has been talking so much about exceptions in the lead-up to the 2024 election.)
Best of all for lawmakers, exceptions allow them to feign empathy and “reasonableness” without actually giving anything up police-wise because they know that their exceptions don’t work. For them, it’s a win-win.
The other reason Republicans love “exceptions,” though, is that they allow them to tap into American misogyny. After all, the very idea of exceptions is built on the notion that some women deserve care while others don’t. Those who have sex willingly are bad girls who should be punished; those who were forced, or who are sick, get a reprieve.
This is where Democrats and the pro-choice movement have a real opportunity to push back. We should be raising the alarm again and again about how exceptions aren’t real; but we also have the ability to point out the misogynist absurdity and hypocrisy of exceptions. If a fertilized egg is a life, and abortion is murder, why do the circumstances for abortion matter? (At least the anti-abortion extremists who don’t want exceptions at all are ideologically consistent.)
What that means, however, is that Democrats need to get comfortable advocating for zero government interference in pregnancy. We have to let go of “exceptions,” too. There’s never been a better time to do so. In fact, it’s downright shameful we haven’t already.
Given how unpopular abortion bans are, how is it possible that the GOP is still framing the debate on abortion? It’s absurd that the national conversation has become a question of when it’s fair to legislate someone’s body. With voters more furious and pro-choice than ever, the most effective message is also the only appropriate answer: never.
Every abortion denied is a tragedy. You don’t have to go into sepsis to be forever harmed by an abortion ban. You don’t need to be raped to have control of your body stolen from you.
And while the most extreme consequences of abortion bans do happen with shocking regularity, they are still outliers: Most people seek out abortions because they don’t want to be pregnant. And that’s okay — in fact, it’s critical.
Reproductive rights and justice isn’t about who “deserves” care, or who has endured enough suffering to have “earned” an abortion. Forcing anyone to be pregnant against their will, for any reason, is immoral and cruel. Yet somehow in the hubbub of polls and bills, talking points and politics, the power of this fundamental truth has been pushed aside.
From the book ABORTION: Our Bodies, Their Lies, and the Truths We Use to Win by Jessica Valenti. Copyright © 2024 by Jessica Valenti. Published in the United States by Crown, an imprint of the Crown Publishing Group, a division of Penguin Random House LLC.
