In June 2022, the United States Supreme Court released a decision to overturn Roe v. Wade, ending a federally guaranteed right to abortion. Within weeks, a 2019 Georgia law banning most abortions was put into effect.
Because of the 2019 abortion law, access to abortion in Georgia has changed dramatically.
The law was held up in court and unable to take effect prior to the Supreme Court ruling. It bans abortion at the first detection of fetal cardiac activity, which is usually around six weeks. But, Emory University Public Health Sociologist Dr. Subasri Narasimhan pointed out, the “six week ban” title is not always accurate.
“The abortion ban that’s currently in place, H.B. 481, technically bans abortion and fetal cardiac activity, which can occur even earlier than six weeks. So we sometimes colloquially refer to it as the ‘six week abortion ban.’ But honestly, once fetal cardiac activity is detected by Doppler [ultrasound], and by a healthcare provider of any kind, that then abortion is off the table,” Narasimhan said.
A fetal cardiac activity ban effectively bans most abortions, since many women do not know that they are pregnant by the first detection of fetal cardiac activity. Gestational age begins at the start of a menstrual cycle, so by the time a period is missed, the gestational age of the embryo is four weeks. The turnaround between the earliest possible detections and the time limit on abortion is narrow.
Narasimhan is against the bans from a public health perspective.
“Are we going to allow people to be able to control whether or not they’re able to carry a pregnancy forward?… I think it’s sort of become, sometimes in the media, a moral question or a philosophical question, but I think when we look at it from a public health and human rights standpoint, abortion bans this really don’t serve any public good,” she said.
The law allows for exceptions to the abortion in cases of rape or incest. In order for an exception to apply, a police report of the rape or incest must be filed. However, many victims of sexual abuse do not report the abuse immediately, if at all. The Rape and Incest Nation Network estimates that more than two out of three sexual assaults are not reported. The victims of these unreported sexual assaults, should they become pregnant, would not be able to obtain an abortion in Georgia.
Dr. Dabney Evans is a public health researcher at Emory University’s Center for Humanitarian Emergencies and a member of the Feminist Women’s Health Center’s board. Evans said that there is no medical reason for this restriction and that it can be harmful to victims.
“One of the things that we know from the Me Too Movement, for example, is that survivors of gender-based violence, whether it’s incest, whether it’s sexual violence, some of them never come forward. Some of them never disclose the abuse that they’ve experienced for a wide range of reasons, including the trauma that they’ve experienced. So, requiring that people disclose within a very short period of time the trauma that they’ve experienced is totally contrary to everything that we know about trauma informed care and survivor centered care. Forcing people to have to disclose…their abuse, and then have to go through a process or procedure to be able to legally access abortion is just basically pouring salt in a wound,” she said.
Clinics in Georgia can help patients figure out their options, even if they cannot provide them with an abortion. The Feminist Women’s Health Center will first medically assess how far along the patient is in their pregnancy. If they are past the limit in Georgia and still wish to have an abortion, the Center can connect them with resources like local abortion funds.
ARC Southeast is an abortion fund helping patients in the Southeast with costs and logistical difficulties to access abortions in another state. Community organizers can also help people in need of abortion.
“Whether people are are able to get an abortion in Georgia or not, places like [the] Feminist [Women’s Health Center] and ARC SE and the community of abortion rights advocates and organizers are going to help people get the care that they want and need,” Evans said.
People of color are more likely to be affected by the higher barriers of access to abortion than white people, according to experts.
“Restrictive policies tend to impact people who experience disproportionate barriers in society. And that includes racial and ethnic minorities, and particularly in Georgia, Black women. And so, when we want to broaden this, we can think about a whole host of, like, intersectional issues that people might encounter in their own lives. This could be [a] lack of financial resources, it could be gender or sexual minority identity. People don’t live single issue lives, to quote Audrey Lorde,” Narasimhan said.
Narasimhan also pointed out that Black women in Georgia face higher maternal mortality rates than white women and that a lack of access to abortion can exacerbate the issue of maternal mortality.
“Once you banned the opportunity for pregnancy termination, that does mean that there will be more pregnancies that are carried. Pregnancy overall has the ability to become emergent at any time. There are lots of complications that happen with pregnancy. Relative to abortion, pregnancy is much more dangerous. Abortion is extremely safe,” she said.
Along with low health risks, abortion regret is uncommon. In a 2020 study conducted by the University of San Francisco, 95% of patients surveyed said they felt like abortion was the right decision six months after the procedure.
The study, called the Turnaway Study, dove deep into the effects that abortion denial has on people seeking it. The Turnaway Study surveyed 1,000 women over the course of five years. The study found that abortion has no significant effect on the wellbeing of those speaking it, but denial of access to abortion does. Abortion denial is associated with higher levels of anxiety, stress, lower-self esteem, and a four-fold increase in the likelihood that the woman’s household falls below the federal poverty level increases four-fold.
Another potential change to abortion access in Georgia post-Roe may be the prevalence of crisis pregnancy centers. The centers often masquerade as legitimate doctors’ offices but are staffed by non-medically trained volunteers. Crisis pregnancy centers aim to dissuade or delay abortion in order to reduce abortion. Narasimhan has focused some of her research on these centers.
“The goal really is to delay until they’re past that gestational age limit or to prey on people’s vulnerability at a certain point, not necessarily give them all of their options… sometimes these are places where people are shamed for even considering or discussing abortion, and then that contributes to a larger climate of abortion stigma,” she said.
Crisis pregnancy centers are often in rural areas with a lack of legitimate obstetrics care, according to Narasimhan. 50% of counties in Georgia do not have an obstetrical provider, according to the Atlanta Journal-Constitution.
Despite the changes to the law, Evans said that she does not believe demand for abortion in Georgia will change. She said, “I would not say that demand has decreased, I think that people will continue to get pregnant. That’s not going to change. People that need abortion care — abortion doesn’t go away when you make it illegal. That’s been proven time and time again. There are a number of countries that have restrictive abortion laws, and some that even ban it outright — it doesn’t make abortion go away. All it does is pushes it underground, and makes it more difficult for people to access care, and in some cases, go to really extreme means to receive abortion care and at times unsafe abortion care.”