As an OB-GYN, an abortion provider, and a researcher who studies abortion and contraception, the work I do is fundamentally rooted in medical evidence and science. That’s why I’ve been so frustrated to see a conversation about abortion dominated by ideologically driven misinformation rather than facts unfold over the last week.
Leading conservative figures have used legislation proposed in Virginia and passed in New York to spread lies about abortion. In fact, all Virginia’s bill would do is end the burdensome 24-hour waiting period, remove the state-mandated ultrasound law, and require one doctor—instead of three—to approve a request for third-trimester abortions. The bill also says the doctor approving the request would no longer need to certify that the harm to the patient’s health would be “substantial and irremediable.” In New York, the law simply removes abortion from the criminal code, codifies Roe v. Wade, and allows patients who need later abortions to get care in their home state rather than travel across the country.
But conservatives have perpetuated dangerous, malicious tropes about patients who seek abortions later in pregnancy and the doctors who provide them—all to advance a political agenda.
One popular talking point from anti-abortion activists, echoed by The View co-host Meghan McCain among others, is that the United States is one of a handful of countries allowing abortion after 20 weeks’ gestation. This is flat-out wrong. In fact, around 65 countries allow abortion at this stage of pregnancy in cases of fetal malformations and anomalies.
McCain is right, in a way, when she portrays the United States as out of step with the rest of the world on abortion policies. But the reasons are different from ones she claims. As my research shows, unlike 78 percent of high-income countries, the United States does not provide public funding for abortion, making us a global outlier in this area. By international standards, the Hyde Amendment—which bans all federal funding of abortion care—is a truly radical and damaging policy, one that disproportionately affects patients of color.
So why do patients seek abortions after 20 weeks? There are many, often intersecting reasons. It is the tragic reality that complications may arise as the pregnancy progresses, some of which may affect the health of the patient or the fetus. And parents may choose to end the pregnancy—a decision that is personal and should not be subject to political interference.
But there’s another factor that exposes exactly why attempts to restrict abortions later in pregnancy for political or ideological reasons are so harmful to patients. Many other countries, including those whose laws about abortions later in pregnancy are more stringent than those in the United States, offer widespread access to early abortion. In contrast, abortion access in the United States largely depends on where you live.
I’ve seen patients who need abortions after 20 weeks because restrictive laws in their state—unnecessary waiting periods, ultrasound mandates, needless and burdensome requirements for providers that cause clinics to close—forced them to delay seeking care. In Texas, after a restrictive law went into effect that led to the closure of half of the state’s abortion clinics, the overall number of abortions dropped—but the number of second- and third-trimester abortions increased, likely because of the delays people faced accessing care earlier in pregnancy.
If conservatives are genuinely opposed to abortions later in pregnancy, they should be doing everything they can to expand access to earlier abortion. Instead, they’re doing the exact opposite; state legislatures across the country are proposing outrageous and unconstitutional bans that could outlaw abortion as early as six weeks into pregnancy, often before patients even know they’re pregnant. If these individuals believe abortion should be illegal entirely—a position dramatically at odds with the views of most people in the United States—they should be truthful about that belief, rather than using patients who need later abortions as a prop to advance their ideology.
Whether we ourselves would have a later abortion is not the question. The question is whether we’re able to show empathy for the patient making that decision. It’s my job as a doctor to support my patients in making the decisions that are best for their situation. When we have this debate, we must center the patients in the conversation, and use evidence-based research and facts to inform policy. I truly hope that Meghan McCain and others fanning the flames of outrage around this issue will take a step back, look at the evidence, and recognize the ways that their rhetoric puts patients and their doctors at risk.
In the meantime, those of us who believe in science should continue to advocate for abortion policies that are grounded in it. That’s the best way forward for patients, providers, and a society that enables its people to live healthy, free, dignified lives.