The overwhelming majority of abortions in this country (more than 90 percent) occur before the pregnancy has reached 12 weeks, and generally less than 1 percent occurs after 20 weeks. As is the case with all health care, however, there are instances in which difficult or unpredictable circumstances can intervene and make accessing an abortion beyond 20 weeks a necessary option for patients to have.
Pregnant people need abortion care later in pregnancy most often related to two factors.
First, is when new medical information becomes available about the pregnancy. This can include fetal anomalies that are not compatible with life, or severe health conditions that develop in the pregnant person.
A second factor could include barriers that have delayed accessing reproductive healthcare, such as lack of insurance coverage for abortion, little access to medical providers or resources, or the need to take time off from work and travel a long distance for medical care.
This is all, of course, within the context of access in North Carolina – a state in which obtaining abortion care is already unnecessarily burdensome. Only nine of our 100 counties have abortion clinics, and our state law requires that patients must receive counseling and then wait 72 hours before they can have an abortion.
With a ban on abortion after 20 weeks now in place (in August, a federal court ordered the reinstatement of a law that had been enjoined until the Supreme Court’s decision reversing Roe v. Wade was handed down) patients in North Carolina who need this crucial, time-sensitive care will now have to travel out of state – which will result in added time, costs, increased safety risks, and unnecessary delays in care – or be forced to carry a pregnancy against their will.
Restrictive laws such as these also place physicians like me in difficult ethical dilemmas in which we must attempt to choose between our obligation to provide the best available medical care to our patients and substantial legal – and even criminal – penalties.
With the reinstatement of this ban, abortions beyond 20 weeks are only permitted in cases of a “medical emergency,” as defined by anti-abortion politicians, not medical providers. Indeed, North Carolina lawmakers amended this law in 2015 to further narrow the definition of a “medical emergency.”
The law dictates that the procedure must be necessary to avoid death or “a serious risk of substantial and irreversible impairment of a major bodily function, not including psychological or emotional conditions.” Again, these types of “one size fits all” bans on medical care deliberately ignore the unique and often complex health conditions pregnant people may be in, and dismiss people’s lives and experiences in pursuit of scoring political points.
Here in North Carolina, it is a felony to willfully perform an abortion after 20 weeks if it does not meet the criteria of a “medical emergency.” Threats like this force doctors like myself to have to consider waiting to intervene until it is somehow more apparent that a situation is truly life threatening, and that the situation will meet the criteria for “legal” set by people whose goal is consolidating political power for themselves, rather than ensuring all patients get the compassionate care they need.
Medical providers may now have to consult with attorneys while also trying to acutely stabilize and care for a very sick patient. And sometimes, in worst-case scenarios, it may result in a doctor being too afraid of litigation, loss of licensure, and even imprisonment, and therefore not providing the essential, life-saving care that a patient needs and deserves.
Like all medical matters, decisions regarding abortion should be made only by patients in consultation with their physicians and health care professionals. Legislators have no business involving themselves in personal medical decisions, and their doing so will only leads to harms, for both patients and providers.
Jenna Beckham, MD, MSPH, FACOG, is a practicing OB/GYN physician in Wake County.