Dr. Emily Boevers, an OBGYN in Waverly, Iowa, photographed her family’s farm in Tripoli. They say the state’s rape exemption requirements threaten privacy, trust and the intimacy of the patient-doctor relationship.
Geoff Stellfox for NPR
hide caption
change the caption
Geoff Stellfox for NPR
After the Supreme Court overturned the federal right to abortion in 2022, many states banned the procedure with the promise that it would be legal in some circumstances, including rape. one learning assessment that over 64,000 pregnancies have occurred due to rape in the year since the decision in the country where abortion is prohibited.
But many people on the front lines of this issue say that abortions in the country after the attacks are difficult or – in some cases – impossible.
There is no central database that measures abortions caused by rape. For this story, NPR looked at state records and talked to researchers, lawyers and doctors in seven of the 11 states where abortion is illegal but legal in cases of rape. Taken together, these accounts reveal the range of laws governing rape exemptions, confusion about who is eligible for exemptions and the role of law enforcement in the process, and widespread fear among doctors about performing abortions on assault victims.
Many victims are unable to report rape immediately
It is all but impossible to know exactly how many abortions are performed because of rape exemptions. When reporting the procedure, the doctor does not have to give a reason. And abortion may have different exceptions – such as fetal anomalies or the life of the mother.
Existing annual data show that in many countries, the number of abortions known to be due to rape is in the single digits or, in some cases, zero.
One reason is that in many countries, rape victims who want an abortion must report the assault to law enforcement. Advocates and medical professionals who work with rape victims say after the attack, there are more pressing issues to consider than abortion laws.
“It’s just too much for them to manage at that point,” says Katy Rasmussen, a nurse who works with assault victims with the Johnson County Sexual Assault Response team in Iowa. The patients he sees are often shocked or experience stigma about sexual assault. If alcohol or illegal substances are involved, Rasmussen said, patients may feel ashamed or even blame themselves.
“Often, survivors of sexual assault just want it to be over,” said Kelly Miller, former executive director of the Idaho Coalition Against Sexual and Domestic Violence. “And having to go through the trauma of reporting, the trauma of a forensic interview, most survivors don’t choose at all.”
Other advocates point out that many patients experience domestic violence when they are raped. That happened to Laurie Bertram Roberts. She said she got pregnant years ago after she was raped by the man she lived with. Reporting him and risking arrest, he said, could mean losing his home.
“We share the house,” he said. “No domestic violence shelter will take me because my family is so big.”
Bertram Roberts, who had seven children, eventually separated from this man. She now works with people in similar situations as part of her work with the Mississippi Reproductive Freedom Fund, a nonprofit organization that helps people seek abortion care in the state.
“There’s a perception of good and bad abortion” among people who defend state abortion bans, Bertram Roberts said. “But the truth is that exclusion is all rhetoric and no practical use.”
Last year in Mississippi, there were zero abortions for reasons, according to new report from the WeCount Society of Family Planning project.
Mississippi Governor Tate Reeves has promised rape exemptions when the state law takes effect in 2022. NPR reached out to Reeves’ office as well as lawmakers in several states sponsoring the ban and to national anti-abortion groups. No one wants to talk about a nationwide rape exemption.
One group, Susan B Anthony Pro-Life America, sent NPR a written statement blaming doctors and the health system for being confused and unable to use the law. “If any doctor is confused about the rape exemption, hospital administration and health associations should provide clarity,” the statement read.
Some doctors said they felt armed and scared
Involving law enforcement makes patients and doctors feel like “potential criminals,” said Jessica Tarleton, an obstetrician in South Carolina, where by law doctors must report rape-induced abortions to the local sheriff’s office.
“Someone comes into the emergency room shot, we don’t ask what they did to get shot. We take care of the patient,” Tarleton said. He points out that no other medicine requires a doctor to legally justify treatment.
“In the last two years,” he said, “I know one patient who is related to me who requested a legal abortion under the rape exception.”
Tarleton tried to provide abortion care whenever he legally could. But she said many doctors in the country are scared and feel they don’t have enough support to provide abortions where they feel they are legal. As a result, he said, many have distanced themselves from the practice.
‘Now I’m an investigator’
Iowa is making it very difficult for rape victims to get an abortion, according to doctors and reproductive rights advocates.
This summer, after a long court battle, the state began enforcing a six-week abortion ban, which made exceptions for certain cases such as rape. But directions from the Iowa Board of Medicine said Doctors – before performing an abortion – must determine whether rape is legal or the risk of legal consequences for noncompliance.
Dr. Emily Boevers said that until now, she had not had to investigate the circumstances of the patient’s rape, but she had done what she would have said that day.
Geoff Stellfox for NPR
hide caption
change the caption
Geoff Stellfox for NPR
This is an unusual level of detail for doctors to collect and document, even among the 10 other countries that include rape exemptions.
“I am now an investigator has decided to determine whether the details of the incident constitute rape under the Iowa Code,” said Dr. Emily Boevers, who works in Waverly, a town of 10,000 in northeast Iowa. They say the requirement threatens privacy, trust and the intimacy of the patient-doctor relationship. “I was supposed to maintain a therapeutic and caring relationship with this patient when I asked him all these details,” Boevers said.
So far, he had not had to investigate the circumstances of the attack with the patient, but he did what he would have said that day. “Unfortunately, our government has mandated that I have to ask some questions,” she said. “If you can answer this, I can help you.”
Those who enforce the law may not understand the law
In some countries, there is a lack of clarity about the rape exemption even among officials tasked with enforcing the law.
Idaho prohibits abortion with exceptions for rape, incest and when the mother’s life is threatened. To request an abortion, a victim of sexual assault must file a police report with a medical provider.
While the state’s ban takes effect in 2022, victim advocates are quick to point out that law enforcement agencies don’t release police reports until cases are closed — preventing victims from accessing timely treatment. The following year, the Idaho Legislature amended the text of the bill so that rape victims have the right to receive, upon request, a copy within 72 hours of the report.
But agencies appear to follow these requirements unevenly.
Boise State Public Radio reached out to 56 law enforcement agencies in Idaho about protocols to help rape victims since the ban. Some said they were complying with the 72-hour amendment and said in-home victim advocates were available to help victims through the process.
Many others are unaware of the amendment. Some public records departments say they will automatically deny requests for copies of reports on open cases, regardless of who made them. One agency realized it was not complying with the law 72 hours after it was enacted and had inadvertently denied records to rape victims.
Local agencies say they have not received guidance from the state.
Advocates say this murky process creates a reporting system that doesn’t favor victims.
“Survivors generally don’t report to this system that was never created to focus on survivors in the first place,” said Miller, former head of the Idaho Coalition Against Sexual and Domestic Violence. accessing this system only for the purpose of obtaining access to an abortion as a result of pregnancy from sexual assault.
State records show there were fewer than 10 abortions for any reason last year in Idaho.
Rape exemption abortion providers are often protected by large institutions
Only a handful of doctors interviewed for this story reported performing the rape-abortion exception with any consistency. Who do all the work in a major academic medical institution.
Dr. Nisha Verma in Georgia estimates she sees a rape or incest victim who meets the exemption standard “every couple of weeks.”
Verma is not an official spokesperson and did not want to be identified using the institution’s name. But he said his employer has protocols and a task force to help doctors manage legal risks. That helps ease doctors’ fears of losing their medical licenses, being fined or going to jail.
“At my institution, we have worked again to create a system that helps us because doctors feel more supported and protected,” Verma said.
But for most people who work with victims, it’s not just a question of how to get an abortion exemption. Some countries, for example, are also limited by the lack of providers willing to deliver babies, let alone perform legally risky procedures.
“The question is,” said Bertram Roberts of the Mississippi Reproductive Freedom Fund, “If you get an exemption in Mississippi, who’s going to perform your abortion?” The country has a a significant disadvantage from obstetricians.
Bertram Roberts said he had never seen anyone in the country get an exemption – for any reason, let alone rape.
