Among states with abortion bans, most pregnancies resulting from rape occurred in states with no exceptions, a cross-sectional study showed.
Since Roe v. Wade was overturned following the U.S. Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision, an estimated 519,981 rapes were associated with 64,565 pregnancies in states with abortion bans, 91% of which occurred in states with no rape exceptions, reported Samuel Dickman, MD, of Planned Parenthood of Montana in Billings, and colleagues.
Texas alone, which has no exceptions, accounted for 45% of these rape-related pregnancies, they noted in a research letter in JAMA Internal Medicine.
Of the 14 states with abortion bans, only five have exceptions: Idaho, Indiana, Mississippi, West Virginia, and North Dakota.
“These laws are structured so that, perhaps in theory, one could get an abortion, but in practice, it’s just not happening and it’s certainly not happening anywhere near the scale that would be needed to provide care for the thousands of women that we estimate have gotten pregnant as a result of a rape,” Dickman told MedPage Today.
He and his team noted that since the Dobbs ruling, “10 or fewer legal abortions occurred monthly in each of the total abortion ban states,” indicating “that persons who have been raped and become pregnant cannot access legal abortions in their home state, even in states with rape exceptions.”
“Survivors of rape who become pregnant in states with abortion bans may seek a self-managed abortion or try to travel (often hundreds of miles) to a state where abortion is legal, leaving many without a practical alternative to carrying the pregnancy to term,” they wrote.
In an editor’s note, Deborah Grady, MD, MPH, of the University of California San Francisco and deputy editor of JAMA Internal Medicine, and colleagues wrote that abortion bans have especially devastating consequences for rape survivors.
“The best solution to this problem is a national law protecting the right of all people to choose to terminate pregnancy,” she wrote. “Failing that, states that limit abortion should take steps to make sure that the process for obtaining an exception to the law is feasible and rapid, particularly for pregnancy associated with rape.”
Melissa Simon, MD, MPH, an ob/gyn at Northwestern Medicine in Chicago and director of the Center for Health Equity Transformation, told MedPage Today that the new research “is both chilling and telling.”
“Although not all people who experience sexual assault and become pregnant may want an abortion, abortion should remain an option because of the violent nature and the violation of human rights and a violation of law during the pregnancy conception,” said Simon. “Therefore, these data, while not perfect due to the databases’ shortcomings as detailed in their research letter, are important to understand the reality of people who are pregnancy capable.”
She urged legislators to understand that abortion bans “have substantial negative impact on the lives of pregnant capable people — especially women.”
For this study, Dickman and colleagues used the CDC’s National Intimate Partner and Sexual Violence survey from 2016 to 2017 to estimate the incidence of vaginal rape. They adjusted for the fraction of survivors who were females ages 15 to 45 using data from the Bureau of Justice Statistics’ annual survey on criminal victimization, which they noted is known to underestimate rapes, and for the percentage of rapes that are vaginal.
Since the data were not state-level, the authors used the Federal Bureau of Investigation’s most recent Uniform Crime Reports, which tallies rapes reported to law enforcement, to estimate the number of rapes per state. They multiplied these estimated numbers by the percentage likely to result in pregnancy and adjusted for the number of months between July 2022 and January 2024 that a total ban was in effect.
They noted that their study has limitations, in part because stigmatized experiences like rape are hard to measure.
Dickman reported that he is a plaintiff in several lawsuits challenging abortion restrictions in Montana.
A co-author reported receiving personal fees from the Society of Family Planning Stipend, as well as grants from the Susan Thompson Buffett Foundation, the Collaborative for Gender and Reproductive Equity, and the Jacob and Terese Hershey Foundation. Another co-author reported grants from the National Research Service Award.
Grady and co-authors had no conflicts of interest.
Simon is an associate editor for JAMA but otherwise had no conflicts of interest.
JAMA Internal Medicine
Source Reference: Dickman SL, et al “Rape-related pregnancies in the 14 US states with total abortion bans” JAMA Intern Med 2024; DOI: 10.1001/jamainternmed.2024.0014.
JAMA Internal Medicine
Source Reference: Grady D, et al “Access to safe abortion for survivors of rape” JAMA Intern Med 2024; DOI: 10.1001/jamainternmed.2024.0019.