States implementing stringent abortion prohibitions declare exemptions for instances of rape and incest. Proponents argue that survivors encounter difficulties in obtaining these exceptions.
Duvall, a survivor of child rape who advocates for reproductive rights, has been in the limelight, appearing in various high-profile campaign ads and addressing the 2024 Democratic National Convention. She recounted the distressing cycle of abuse that led to her pregnancy in Kentucky and discussed the limited options she had regarding her predicament.
Currently, a 12-year-old rape victim in Kentucky would have no in-state alternatives to consider.
Kentucky is among the 13 states with almost complete abortion bans—these laws theoretically include exceptions to protect the life of the mother. It is also one of the 10 states that, according to a KFF analysis, has abortion bans or early-term restrictions without exceptions for cases of sexual assault.
Duvall also appeared in a campaign ad for Kentucky's Democratic Gov. Andy Beshear, who criticized his state's abortion law for providing more rights to rapists than to their victims.
Shifts in policies resulting from legal challenges to abortion bans have occurred in the years following Roe v. Wade's overturning in 2022.
In the advert, Duvall states, "Sixty-four thousand pregnancies from rape have occurred in states with total abortion bans, and Trump did this." She emphasizes, "Women and girls need to have choices. With Kamala Harris, we do."
Former President Donald Trump appointed three of the five justices on the US Supreme Court who voted to overturn Roe v. Wade in 2022. Trump, during the most recent presidential debate, expressed support for exceptions in the cases of rape, incest, and when the life of the mother is at risk.
However, doctors and reproductive health specialists argue that these exceptions, often prominently touted as components of a more empathetic anti-abortion approach, are not designed to actually aid survivors in accessing abortion care.
In practice, exceptions are elusive
“Abortion ban exceptions do not work, and in many ways, they are merely marketing gimmicks from anti-abortion politicians, suggesting that there are exceptions for those in specifically challenging circumstances. However, this is largely untrue,” says Elisabeth Smith, director of state policy and advocacy at the Center for Reproductive Rights. Her organization has been involved in numerous legal disputes regarding abortion ban exceptions.
While many anti-abortion groups believe exceptions should not be granted, not even in cases of rape or incest, some argue that exceptions must be “tolerated” to justify further restrictions on reproductive care.
The anti-abortion group Missouri Right to Life declares on its website, “Each human being, regardless of how they are conceived, deserves protection under the law; however, MRL may be forced to tolerate the inclusion of rape or incest exceptions in certain measures to achieve more protection for the unborn than what currently exists.”
There are 11 states with abortion bans or early-term restrictions that include exceptions for cases of sexual assault, according to KFF researchers. Nevertheless, a combination of scarce provider availability, reporting requirements, and pregnancy term limits renders these exceptions impractical for many.
“I am not aware of any single instance of a rape victim who is pregnant being able to get an abortion in a state with total abortion bans utilizing these exceptions,” remarks Dr. Samuel Dickman, a practicing abortion provider and Planned Parenthood's Montana chief medical officer.
Most abortion providers have closed their doors in states with bans, notes Dickman. Doctors working in hospital OBGYN units in states with abortion bans have described witnessing their colleagues relocate to states where they can practice without limitations.
Even if a survivor qualifies for an abortion under such an exception, “Who are they going to call? There are no abortion providers in those states anymore,” asserts Dickman. “That's the beginning and end of the story.”
Rather than undergo the procedures required to meet the criteria for an abortion exception, it's more likely a pregnant rape survivor will leave a state with restrictive abortion policies to seek care, according to Dickman.
He has encountered numerous women seeking help at his Montana clinic, many of whom had traveled from Idaho recently.
Rape and incest exceptions to Idaho's abortion ban are limited to the first trimester. A pregnant person must report the assault to law enforcement and provide them with a copy of the report to receive an abortion.
Idaho Gov. Brad Little, a Republican, supports the pro-life policies in his state's law but voiced concerns about access to abortion for survivors.
“The challenges and delays associated with obtaining the necessary police report render the exception largely meaningless for many. I am particularly concerned for those vulnerable women and children who lack the capacity or familial support to report incest and sexual assault,” wrote Little in 2022.
Most rape and incest exceptions mandate a reporting requirement, often imposing a tight deadline. West Virginia, South Carolina, Mississippi, Idaho, and Georgia require rape survivors to report the assault to law enforcement, while each of these exceptions necessitates a victim to recount the assault's gruesome details to another person, which can adversely affect their mental health, Dickman said.
Advocates protest that these strict deadlines for reporting are not feasible for individuals already dealing with trauma. In fact, these reporting requirements might be purposefully set to hinder people from obtaining necessary care, believes Madeline Gomez, Planned Parenthood's senior policy counsel in charge.
CNN attempted to receive a comment from the governor's offices in Iowa, Idaho, and Kentucky, but they remained unresponsive.
In Gomez's opinion, there's a harmful belief that individuals seeking abortions will lie to access healthcare. This belief is fueled by outdated, harmful stereotypes, she explains, such as assumptions that women are dishonest or untrustworthy, and that survivors' testimonies should be disregarded.
Because a significant number of sexual assault survivors opt not to report the incident to authorities, determining the actual number of rape victims seeking abortions becomes quite complex, experts say. Dickman collaborated on research published in the JAMA Internal Medicine journal, suggesting that around 520,000 rapes caused 64,565 pregnancies in the 14 states that enforced abortion bans following the Supreme Court's annulment of Roe v. Wade and the termination of the federal right to abortion.
“The prevalence of rape-related pregnancies – it’s an all too common occurrence, and trying to safeguard survivors of rape while simultaneously restricting abortion for all others simply doesn’t make sense,” Dickman expressed.
Many of these sexual assault survivors are among the expanding number of patients traveling to neighboring states to acquire an abortion – one in five patients, according to a December 2023 study by the Guttmacher Institute, an organization dedicated to healthcare research and supporting abortion rights. Nevertheless, this option might not be accessible to everyone, including low-income or underage survivors likely to continue living with their abusers, Smith suggests.
“There’s every reason to suppose that rape and incest survivors are even more likely to be compelled to carry forth these pregnancies,” Dickman noted. “If they're living with an abusive partner, if they're living in a perilous environment, that will make it more challenging to travel to another state for a fundamental medical service.”
A concerning pattern
Instead of repealing these bans, legislators in numerous states have worked to make rape and incest exceptions more difficult to access, Smith pointed out, referencing pregnancy term limits placed on exceptions in states like Idaho and Georgia.
A Republican-led Senate voted down the inclusion of rape and incest exceptions in Missouri's abortion ban in February. Similar bills were rejected by Republican legislators in Louisiana in May, according to the Associated Press.
Explaining her vote against adding exceptions for victims of rape, Louisiana state Rep. Dodie Horton claimed, “I think we should punish the perpetrator to the fullest extent, I'd love to hang them from the highest tree if it were within my power. However, I cannot support aborting the innocent,” according to the AP report.
“If legislators genuinely wanted the exceptions to be applicable, they could have made them applicable, but they haven’t,” Smith remarked.
CNN reached out to Louisiana lawmakers for comment but did not receive a response.
Supporters of abortion rights are optimistic about the November election, as potential ballot measures in various states could restore abortion protections.
Rape and incest exceptions to abortion bans were not always the standard, and they might not continue to be so, explains Mary Ziegler, a law professor at UC Davis' School of Law concentrating on reproductive care.
“From the beginning, the anti-abortion movement was concerned that rape and incest exceptions would serve as a loophole for having elective abortions,” Ziegler stated. “Written rape and incest exceptions in subsequent years – to the extent they even still existed – were designed to make it more difficult for individuals to leverage these exceptions.”
Ziegler has emphasized that the trend in states excluding rape and incest exceptions from abortion bans may pave the way for other limiting policies.
“I'm not sure how promptly we'll observe legal proceedings against abortion itself, but I think there’s a trajectory indicating that this may happen,” she predicted.
CNN's Deidre McPhillips contributed to this report.
Despite Duvall's advocacy and the inclusion of rape exceptions in some abortion bans, Dr. Samuel Dickman, a practicing abortion provider, confirms that these exceptions are often impractical and elusive for survivors. Many providers have closed their doors, making it difficult for survivors to access care. In some states, survivors must meet strict reporting requirements, which can be challenging and time-consuming, making the exception largely meaningless for many.
