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Indiana’s abortion ban has few exceptions. But navigating them can be difficult for providers

By Abigail Ruhman

Posted January 15, 2024

The American College of Obstetricians and Gynecologists said it’s “impossible” to create an inclusive list of what qualifies as a medical emergency, and creating a “finite” list is dangerous. (WTIU)

One of the few, narrow exceptions of Indiana’s near-total abortion ban is if the pregnant person’s health or life is at risk. However, some providers say because the ban’s language is vague, they have concerns about the potential legal risk of determining what qualifies under the exception.

Since the ban went into effect, providers have had to navigate what the exceptions look like in practice.

Dr. Caroline Rouse, a maternal and fetal medicine specialist at Riley Hospital for Children at IU Health, said there is no universal definition of what qualifies as “health or life threatening.”

This can lead to hard questions for the provider.

“Is the person sick enough right now for me to determine that this pregnancy is healthy or life threatening?” Rouse said. “Do I have to wait for this person to become more ill in order for us to intervene?”

Indiana code says abortions are allowed if “reasonable medical judgment” determines the pregnant person is at a “serious risk of substantial and irreversible physical impairment of a major bodily function.”

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Rouse said this standard is meant to mitigate the harms of maternal mortality, but there are less risks associated with abortions. One study found the risk of death for pregnancy is 14 times higher than the risk of death for abortion.

But, the discussion of risk for patients and providers isn’t just about the most extreme outcome.

“There are complications other than death related to pregnancy,” Rouse said. “So people can have long term kidney problems, liver problems, heart problems, stroke, blood clots, all of these things are at higher risk.”

Rouse said the ban uses non-medical language that makes it difficult to apply to each patient.

“Each individual patient comes with their own experiences, their own medical issues, their own risk tolerance, their own reasons for seeking abortion care,” Rouse said.

In addition to limiting when patients can seek abortions, Rouse said the language of the ban puts additional pressure on providers.

“You're basically telling an entire field that they are not able to legally practice this one incredibly, critically important part of their field, for reasons that have nothing to do with the medicine,” Rouse said.

Rouse said doctors are being asked to make a “legal determination” which can feel like trying to predict future legal ramifications and how a complication may develop throughout the course of the pregnancy.

“People go into medicine because they want to help people,” Rouse said. “And this law is explicitly preventing us from being able to do so.”

Rouse said providers are still able to give patients information on how to obtain a legal abortion if that is what they want. She also said IU Health can help patients seeking abortion services.

Abigail is our health reporter. Contact them at aruhman@wboi.org.