Americans favor abortion exceptions for victims of rape. But the policies don’t work.

The experience of a 10-year-old rape victim in Ohio who had to travel to Indiana for an abortion drew national attention because it was horrific — and because most Americans believe it shouldn’t have happened.

“I think people thought there would be more exemptions,” said Elizabeth Nash, principal policy associate at the Guttmacher Institute. But the lawmakers drafting abortion bans “are not interested in exceptions — they see them as loopholes,” she said. “And when there are exceptions, they are incredibly narrow.”

“Exemptions are bullshit,” said Laurie Bertram Roberts, executive director of the Mississippi Reproductive Freedom Fund. They’re written to make it seem like abortion will be legal in these extreme circumstances, she said, “but in function and form it will not be.”

Exceptions for rape or incest predate the most recent round of abortion restrictions. The Hyde Amendment, which has prevented Medicaid from covering abortion since 1976, does not apply in cases of rape or incest.

“For states that were doing life, rape, incest exceptions only, there really aren’t any abortions being paid for under Medicaid,” said Nash.

Compounding trauma

“Most people never tell anybody that a pregnancy is the result of rape or incest,” said Grace Howard, an assistant professor of justice studies at San José State University. Victims’ reasons for not reporting assaults to police “are basically infinite,” she added. They include worries about not being believed, fear of retaliation and general distrust of law enforcement. “There’s not a good record of police treating sexual violence victims well,” Howard added.

And people who do end up reporting don’t necessarily do it immediately. “There’s added trauma to have to report the assault. You have to relive things, and you may not be prepared to do that right away,” said Nash. “It may take time, and when you need an abortion, time is not in your favor.”

Howard agreed. “Take one of the most stigmatized things in our society and add another one of the most stigmatized things on top of it, and then add a ticking clock,” she said. “It’s not workable.”

Many people who have been assaulted may not even consider themselves victims, said Barbara Sheaffer, medical advocacy coordinator at the Pennsylvania Coalition Against Rape. The CDC’s 2016-2017 sexual violence survey found that nearly 60 percent of women reported sexual coercion by an intimate partner over their lifetimes, and nearly 40 percent reported being raped by their partner.

For a person who has just undergone a major violation of their bodily autonomy in the form of sexual violence, being unable to access healthcare is a violation of human rights that compounds the initial trauma, said Manisha Shah, senior director of crime-victim assistance at the non-profit group Safe Horizon. “Preventing someone from making a choice about their own body is one of the most powerful and destructive ways to exert power and control,” she said.

When having an abortion isn’t possible for people in these situations, Shah said, abusive relationships become more difficult to escape: “Reproductive rights and the right to live free from intimate partner violence are sides of the same coin.”

Minors face even more barriers to access

Understanding and reporting sexual assaults and abuse may be even more difficult for minors, who might not have the knowledge or support to recognize that what has happened is a crime or how to report it. That’s especially true if their abuser is a family member or authority figure, which is often the case when a child is sexually assaulted. Only 12 percent of child sex abuse is reported to the authorities, according to the National Sexual Violence Resource Center.

“It almost makes my head explode to think about what that would be like for a young child,” Sheaffer said. “Something has happened to them which is a crime, and it’s incredibly wrong in a million ways. What would that even be like, emotionally, to realize, and even have the wherewithal to know what’s happening to their bodies? Who is it safe to tell? What options do they even have?”

Some states allow minors to bypass parental consent requirements by appearing before a judge, which involves navigating a complicated legal and logistical maze. “You’re expecting someone who’s potentially of single-digit age to figure out this process where you have to physically go before a judge and convince them that you are mature enough to be making the decision, on your own, to not stay pregnant,” Howard said. “How do they find this out? How do they get a ride?”

Fewer providers to turn to

Rape victims who manage to qualify for an exception may still struggle to find access in their states as abortion clinics close and providers fear lawsuits. That will likely force many to travel out of state to receive care that they should, by law, be able to access closer to home.

In Mississippi, whose 2018 ban on abortions after 15 weeks prompted the legal challenge that ended with the Supreme Court overturning Roe v. Wade, the state’s last abortion clinic closed its doors earlier this month. Its shuttering coincided with the onset of a near-total ban on abortions, with limited exceptions for rape and saving a mother’s life. “Who’s gonna be the provider now that we’ve closed the only clinic that was left in the state?” Roberts said.

North Dakota, which also allows abortion in cases of rape and incest, will soon lose its last clinic, too.

As cases like the one in Ohio accumulate, public pressure may force lawmakers to carve out more rape and incest exceptions in their abortion bans, Nash said. But given how unworkable these are in practice, such gestures would be largely empty.

While abortion advocates outline all the unforeseen consequences to even bans with exceptions, many view it as the logical consequence of the Supreme Court’s rejection of a constitutional right to privacy in Dobbs v. Jackson Women’s Health, the case that resulted in Roe’s downfall.

“Any pregnant person should be able to have access to complete reproductive care because we just don’t know everybody’s story,” Sheaffer said. “Nor is it ours to judge.”