by victoria colwell
(Opinion Piece)
Advocates for the importance of reproductive healthcare rightfully point out the variety of services under its umbrella. Its wide range, extending beyond elective abortions, should be acknowledged and respected. However, the validity and merit of elective abortion should not be lost in the conversation.
Disclaimer: I am not a medical professional. Sources for claims are included both in text and in the ending bibliography.
The Landscape of the Issue
The issue of reproductive health in the United States, and the need for education on its full scope, is arguably more relevant than ever before. Since the 2022 reversal of Roe v. Wade returned control over abortion laws entirely to the states, it’s hard to overstate the extent of its effects.
Twenty-five states have tightened abortion restrictions, often with varying exceptions, such as in the case of rape or incest, danger to the life of the mother, or the lack of a viable fetus. However, these caveats are often vaguely worded and lack specifics on what constitutes necessity. This grey area can leave people falling through the cracks and put lives at risk.
The reversal has also empowered states to limit access to comprehensive sex education. In the case of Texas, this means an abstinence-only education based on the debated belief that life begins at conception. The lesson plans often mandate live ultrasound viewings, while omitting information about consent, contraception, or LGBTQ+ issues. This example reflects the lack of federal regulations around sex education, where only seventeen states require the lesson plans to be medically accurate (14).
A Possibly Misleading Distinction
As the wide-reaching impact of these restrictions sinks in, voices for reproductive health are rightfully advocating for its importance and a fuller understanding of what it entails. Due to its broad yet complex nature, involving access to everything from clinics to condoms, supporters attempt to highlight the nuance of the issue by saying it’s about “more than just [protecting the legal right to an] abortion.”
In attempting to educate people on the true nature of reproductive care, the translation of this message into media can include the phrase “more than just abortions,” such as on multiple episodes of Grey’s Anatomy. In one instance, it’s even recited by Dr. Carina DeLuca, an obstetrician-gynecologist (OBGYN) character.
The intentions behind this distinction are often clear: to broaden understanding of reproductive health beyond the assumptions about elective abortion, including that it’s always out of personal choice. However, its use can have the accidental effect of pushing stigma around abortion and diminishing its medical necessity. While examining the delicate line people must walk in advocating for the full scope of reproductive care, it’s necessary to credit their likely intentions in making this separation.
Nonetheless, it’s important to reinforce the need to respect the agency of those choosing an abortion for non-medical reasons. Additionally, the nuance of reproductive care highlights the subjective nature of terms like “medical necessity” and “danger to the life of the mother,” which can lead to further failure to meet patients’ needs.
A Diminishing Effect
It’s essential to acknowledge the wide scope of reproductive and abortion care, as it does extend beyond elective abortion. Word choice is crucial when making this distinction, as miscommunication can reinforce limiting assumptions about the purpose of elective abortion. Therefore, it’s essential to reinforce the individual merit of this procedure, both for medical and non-medical reasons.
While people may seek abortions for personal or financial reasons, many others may be terminating wanted pregnancies for their physical or mental well-being—sometimes even for their survival.
…With Understandable Intentions
With that said, it’s fair to assume that iterations of the “more than just abortion” sentiment are referencing the definition of an induced abortion: the termination of an otherwise viable pregnancy. It highlights the fact that the umbrella term of “abortion care” also includes the termination of nonviable pregnancies and medical treatment following a miscarriage. While these situations don’t have a universally used title, they are commonly referred to as termination for medical reasons (TFMR). This variety emphasizes the complex nature of the issue, since it calls into question what qualifies an abortion as such.
Assuming Motives
Regardless of the earnest intentions of this distinction, it reinforces assumptions about the motives behind an abortion—including that an elective abortion is entirely due to personal choice. This fundamentally downplays the critical role of abortion as a form of medical treatment, even in cases that don’t fit the nebulous definition of threatening the mother’s life or health.
Medical Intervention Through Elective Abortion
Conditions within the mother or fetus that may either require or be essentially treated with an elective abortion include:
- Pulmonary hypertension
Whether or not the pregnant person has already experienced cardiac issues, pregnancy can put severe strain on the heart and elevate blood pressure to dangerous levels, causing a 50% mortality rate. Although the condition does not necessarily make a pregnancy nonviable, it nonetheless poses a severe risk to the expecting parent.
- Preeclampsia or eclampsia
Besides pulmonary hypertension, pregnancy can cause severe preeclampsia—or dangerously high blood pressure—for numerous reasons. This condition can cause dangerous complications, including organ failure, stroke, and placental abruption. In some cases, it can escalate to eclampsia, a more severe form characterized by seizures and a higher fatality rate.
In some cases, treatment may include an induced delivery, which is considered an abortion if performed before 24 weeks of gestation due to the low likelihood of fetal survival. This classification further demonstrates the unclear definition of an otherwise viable pregnancy.
- Kidney disease
Though some with mild kidney disease may be able to carry a healthy pregnancy, those with more severe forms may be advised to terminate the pregnancy to avoid life-threatening complications.
- Cancer
Regardless of when exactly cancer begins developing, it may evolve during a pregnancy to the point of requiring treatment to prevent life-threatening consequences. While cancer treatment options for pregnant patients have improved, many, such as radiation, are inherently hostile to a developing fetus and may lead people to choose abortion. However, some states prohibit access to abortion in these cases, which can exacerbate the condition.
- Cardiomyopathy
Cardiomyopathy is a disease of the heart muscles that affects their ability to pump blood effectively. It has several variations: hypertrophic cardiomyopathy (HCM), in which the muscles are thickened, and dilated cardiomyopathy, in which the chambers are thin and stretched.
While some pregnant people with cardiomyopathy can avoid complications, some can see their condition worsen under the additional stress.
- Infection (Sepsis, chorioamnionitis, etc.)
Infection is a broad term, including conditions such as sepsis and chorioamnionitis (an infection of the amniotic sac). These don’t necessarily make a pregnancy nonviable, but they can quickly turn the tables.
Whether infection occurs in an otherwise viable pregnancy or as a result of an improperly treated miscarriage, it nonetheless places lives at risk. Regardless of the scenario, affected people and their physicians are subject to a legal grey area that prevents essential care and endangers lives. For instance, Texas has seen a fifty percent increase in cases of sepsis among those who lost their pregnancy in the second trimester.
- Psychiatric conditions
These are arguably the toughest conditions to believe warrant a medically necessary abortion, as the severity of mental illness is still largely misunderstood. The primary risk lies within medication management. While many psychotropic medications pose a risk to the developing fetus, there are significantly more risks to stopping the medication.
In those with disorders like bipolar or schizophrenia, for example, suddenly ceasing necessary medications could increase the risk for psychotic episodes or suicide, among other harrowing outcomes. Beyond the psychological symptoms, untreated mental disorders, namely depression, can have physiological effects such as low birth weight and premature birth (2).
An Unclear Urgency Threshold
It’s unclear what constitutes enough threat to the patient’s life to justify medical intervention, and this ambiguity can have devastating consequences.
Termination for Medical Reasons (TFMR):
Although the above conditions may warrant an abortion for the mother’s health and safety, termination in those cases is still widely considered elective. By comparison, other situations more explicitly meet the threshold of medical necessity—though the criteria for this classification are still largely inconsistent.
That being said, here are a few examples of conditions that may warrant the termination of pregnancy for medical reasons (TFMR):
- The Miscarriage Question
This is a notable example of the nuanced definition of abortion and how it often hinges on context. A dilation and curettage (D&C) is a procedure commonly used in abortions, as well as after a miscarriage. Although the procedure is identical, the reason for undergoing it determines its classification as part of an abortion. The same is true of the medications mifepristone and misoprostol, a pairing commonly prescribed in both situations (21).
Prohibition of abortions and the means of performing them often also affect doctors’ ability to treat miscarriages.
- Ectopic Pregnancy
This is another example of inconsistency as to what differentiates an abortion from a termination for other reasons. An ectopic pregnancy occurs when a fetus begins developing outside the uterus, such as in the fallopian tubes. If left untreated, an ectopic pregnancy can cause fatal hemorrhaging, such as by rupturing a fallopian tube.
Since fetuses cannot develop normally outside of the uterus, all ectopic pregnancies are considered nonviable (16). Some sources classify the termination of such pregnancies as an abortion, though this contradicts its standard definition as ending an otherwise viable pregnancy (15).
- Previable Preterm Premature Rupture of Membranes (PPROM)… depending
Prelabor Premature Rupture of Membranes (PPROM) involves the rupture of the amniotic sac, or the “water breaking,” before thirty-seven weeks of gestation, and before labor officially begins. Previable PPROM occurs when the fetus cannot survive outside of the uterus, and periviable PPROM occurs when the fetus may survive on life support.
All variations of the condition place the mother at considerably higher risk of life-threatening complications, including placental abruption, hemorrhaging, and sepsis.
Options for intervention include close monitoring (expectant management), termination, induced labor, or surgical intervention.
- Fetal anomalies (i.e., anencephaly, trisomy 13/18, etc.)
Fetal anomalies are an admittedly broad category, and include conditions like anencephaly, where the fetus’s brain or skull is underdeveloped.
Pregnancies where fetal anomalies are present are commonly treated through termination, using many of the same methods as in elective abortions. Thus, they are under similar threats from post-Dobbs restrictions.
On the Line, Nonetheless
It makes sense that advocates for abortion care feel the need to distinguish between the termination of a viable and a nonviable pregnancy, as it showcases the range of situations that fall under the umbrella. They also may be attempting to draw attention to the fact that TFMR is also very threatened by post-Dobbs abortion restrictions, even though some may view it as inherently more urgent than other cases.
Several states, including Tennessee, completely ban abortion with no exceptions, including in cases of medical necessity. This places physicians between a rock and a hard place, where they either leave patients in potentially life-threatening pregnancies or face criminal prosecution (6).
Besides the banning of the methods necessary for termination, these legal restrictions force doctors to delay critical treatment—sometimes with deadly consequences.
Twenty-eight-year-old Josseli Barnica, for instance, endured a miscarriage at seventeen weeks of gestation. Though she emphatically requested medical intervention out of concern for her health, doctors were unable to treat her until the fetal heartbeat stopped on its own. She was forty hours into this forced wait when she ultimately died from sepsis (11).
The United States already has the highest maternal mortality rate in the developed world, and these restrictions will certainly only worsen that margin. Besides explicitly endangering pregnant people’s lives, these laws are noticeably driving OBGYNs out of affected states, thus creating “OB deserts,” and depriving additional people of adequate reproductive healthcare (9).
In addition to threatening the lives of mothers, these policies have coincided with an increase in infant mortality, since medical intervention in cases of fetal anomalies is limited or outright banned.
Quieting the Voice for Personal Choice
Considering how the “more than just abortions” sentiment inadvertently minimizes the full scope of their importance, we must try to avoid doing the same toward elective abortions performed outside of medical necessity.
Whether the mother is a survivor of rape or incest or lacks the financial or emotional means to be an adequate parent, it’s only fair to acknowledge the critical role an elective abortion plays in maintaining one’s mental health and quality of life.
A Need for Empathy, Logic, and Understanding
Differentiating between abortion and other forms of reproductive care has understandable intentions—to educate people on the scope of abortion care, including beyond elective situations. However, this distinction can reinforce the idea that an elective abortion is only ever voluntarily chosen for personal reasons, thus oversimplifying the context of such a decision. This can downplay the role of the procedure as essential medical treatment, which extends outside the poorly defined realm of “danger to the life of the mother.”
The difference between these motivating factors also highlights the ambiguity of these qualifying terms in abortion care. Issues such as what poses a significant enough risk to the mother’s health, or what counts as an otherwise viable pregnancy, are difficult to define. However, they can draw the line between abortion and miscarriage management or termination for medical reasons.
These blurred lines can easily extend into legislation around reproductive care, which has observably increased risk to the lives of mothers and infants, and limited doctors’ ability to intervene—often with deadly outcomes.
A key ingredient in the discussion and debate surrounding abortion and reproductive care is empathy and understanding. It is not constructive to demonize pro-life advocates or make assumptions about their character. However, we can also acknowledge the unethical nature of legislating healthcare based on personal beliefs, no matter how strongly they are held. We must consider the medical facts and measurable statistics around this issue, specifically in the wake of the post-Dobbs bans, as well as how unclear wording can further misunderstanding.
Sources:
- “Abortion.” (17 May 2024). World Health Organization. Abortion
2. “Abortion Can Be Medically Necessary.” (25 September 2019). ACOG. https://www.acog.org/news/news-releases/2019/09/abortion-can-be-medically-necessary
3. “About.” Liberate Abortion. About — Liberate Abortion
4. Armstrong, Carrie. (15 September 2008). “ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation.” AAFP.
ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation | AAFP
5. Bliss-Carrascosa, Sofia, and Louis Jacobson. (21 June 2023). “How state abortion laws changed after the Dobbs decision reversed Roe v. Wade.” Politifact.
PolitiFact | How state abortion laws changed after the Dobbs decision reversed Roe v. Wade
6. Branstetter, Ziva. (29 March 2023). “How Abortion Bans Are Impacting Pregnant Patients Across the Country.” ProPublica.
The Legal and Medical Impact of Recent Abortion Restrictions — ProPublica
7. Chisholm, Margaret, and Jennifer Payne. (20 January 2016). “Management of Psychotropic Drugs During Pregnancy.” Heartbeat International.
Management of Psychotropic Drugs During Pregnancy
8. “Dilated cardiomyopathy.” (4 May 2022). Mayo Clinic. Dilated cardiomyopathy – Symptoms & causes – Mayo Clinic
9. Gunja et. Al. (4 June 2024). “Insights into the U.S. Maternal Mortality Crisis: An International Comparison.” The Commonwealth Fund.
U.S. Maternal Mortality Crisis Comparison | Commonwealth Fund
10. “Hypertrophic cardiomyopathy.” (23 February 2024). Mayo Clinic. Hypertrophic cardiomyopathy – Symptoms and causes – Mayo Clinic
11. Mather, Mark, and Rachel Yavinsky. (7 August 2025). “Abortion Bans Linked to Sharp Rise in Sepsis, Infant Death, and Pregnancy-Associated Deaths, New Research Shows.” PRB. Abortion Bans Linked to Sharp Rise in Sepsis, Infant Death, and Pregnancy-Associated Deaths, New Research Shows | PRB
12. “Meredith Presents the Catherine Fox Award to an Unexpecting Winner- Grey’s Anatomy.” ABC, YouTube. https://www.youtube.com/watch?v=XGkpOC9qGp8
13. “Everyone Rallies Around Bailey- Grey’s Anatomy.” ABC, YouTube.
14. Nettle, Nadra. (21 July 2022). “Sex Ed Was in Trouble Before Roe Reversal. Now the Curriculum Matters Even More.” The 74.
Sex Ed Was in Trouble Before Roe Reversal. Now the Curriculum Matters Even More – The 74
15. “Peripartum Cardiomyopathy and Pregnancy Issues.” National Heart, Lung, and Blood Institute, NIH.
https://www.nhlbi.nih.gov/health/cardiomyopathy/pregnancy
16. “Preeclampsia and Eclampsia.” Cedars Sinai. Preeclampsia and Eclampsia | Cedars-Sinai
17. Robertson, Rachael. (19 December 2024). “6 Medical Reasons for Abortion.” Everyday Health. 6 Medical Reasons for Abortion
18. Santiago-Munoz, Patricia. “The truth about ectopic pregnancy care.” UT Southwestern Medical Center.
The truth about ectopic pregnancy care | Your Pregnancy Matters | UT Southwestern Medical Center
19. “Terminating a Pregnancy for Medical Reasons (TFMR).” Tommy’s. Terminating a Pregnancy for Medical Reasons (TFMR) | Tommy’s
20. “Termination for fetal anomaly.” NHS. Termination for fetal anomaly – NHS
21. Theard, Gabi. “What’s the Difference Between a D&C and an Abortion?” (17 Dec 2024). Metropolitan Family Planning Clinic.
What’s the Difference Between a D&C and an Abortion? – Metropolitan Family Planning Institute
22. “When Your Water Breaks Too Early: Previable and Periviable PPROM.” Society for Maternal-Fetal Medicine. High Risk Pregnancy Info.
PPROM — High Risk Pregnancy Information
23. Xing et. Al. (8 June 2023). “Abortion rights are healthcare rights.” JCI Insight, The American Society for Clinical Investigation. National Library of Medicine, NIH.