20-Week Abortion Ban From Tennessee Means Big Changes for Pregnant Women

The governor of Tennessee recently signed a bill into law, effective July 1, which further regulates abortion in the state. Under this newly enacted measure, called the “Tennessee Infants Protection Act,” doctors are subject to criminal liability if they perform an abortion on a viable fetus and fail to show it was necessary to prevent the death or substantial and irreversible harm to the pregnant woman’s major bodily functions. A doctor may face license suspension and imprisonment for failing to comply with the act.

What Constitutes a “Viable” Fetus?

Under the act, once a fetus is viable, abortion is prohibited. “Viable” is defined as the stage of fetal development when an unborn child is able to survive outside the womb, with or without medical intervention. In Tennessee, there is a “rebuttable presumption” of viability at the gestational age of 24 weeks. (Gestational age is calculated from the first day of a pregnant woman’s last menstrual period.)

Though the act is often termed the “20-week abortion ban,” proponents of the act argue it merely requires doctors to assess fetal viability at the 20-week point in gestational age, if there is no medical emergency warranting a physician to immediately induce or perform an abortion. A physician’s good faith medical judgment that the fetus is not viable is an affirmative defense under the act.

What Medical Conditions Fall Under the Act?

If a physician determines the fetus is viable, the other affirmative defense is the abortion was necessary to save the pregnant woman’s life or prevent “serious risk of substantial and irreversible impairment of a major bodily function.” There are certain medical conditions which can complicate pregnancy and potentially cause death or “substantial and irreversible impairment of a major bodily function.” Examples include, but are not limited to, pre-eclampsia, diabetes, and multiple sclerosis. However, any condition relating to a pregnant woman’s mental health, regardless of the reason, does not fall within the purview of the act. In addition, the act does not include cases in which a woman’s own conduct results in substantial bodily harm or her death.

The Impact of the Act on Pregnant Women in Tennessee

Among the potential obstacles for pregnant women in Tennessee are the narrow exceptions provided for an abortion to be permitted under the act. The prevention of death or substantial harm to a woman’s health are the only exceptions. Circumstances of rape or sexual abuse which can result in pregnancy are not exceptions under the act. This is particularly problematic if a woman does not know she got pregnant as a result of the abuse until later in her pregnancy. Additionally, what if the ultrasound routinely performed at 20 weeks reveals a serious abnormality with the fetus? Due to the narrow exceptions under the act, a pregnant woman receiving such news would automatically be prevented from making the right, albeit difficult, decisions for her and her family.

Further, if the woman’s physician determines an abortion is necessary to save her life or prevent substantial harm to her health, this conclusion is not enough. Under the act, a second physician, who is not professionally related to the first physician, must make the same determination and certify it in writing. This requirement can delay a woman’s ability to receive the necessary medical treatment for a potentially life threatening condition. As long as her condition is not an emergency (the need for an abortion is not immediate), she must get the second opinion. In addition, access to the second physician might be problematic. Per the act, the two physicians cannot be professionally connected, which means the pregnant woman, already in a fragile state, might need to travel in order to receive the second opinion. In the meantime, during such delays, family members–partners, spouses, young children–who depend on the pregnant woman will be negatively affected. Also, as mentioned above, the act does not allow conditions relating to mental health to come under the exception. However, such conditions can still have a detrimental impact on a pregnant woman and her loved ones.

Regardless of where one stands in this debate, the act will undoubtedly impact pregnant women in Tennessee who seek an abortion for various reasons. Proponents of the act question how a doctor or pregnant woman could proceed with a late term abortion, especially when it is proven the fetus could thrive as a human being outside the womb. On the other hand, the act’s opponents argue it infringes on a woman’s constitutional right to decide what is right for her and her body, as well as impedes her ability to do what is best for her family and work with her doctors regarding her health and well-being.