Confusing abortion bans hurt patients. But there's a cost to making them clearer.

Vox

01-07-2025

is a policy correspondent for Vox covering social policy. She focuses on housing, schools, homelessness, child care, and abortion rights, and has been reporting on these issues for more than a decade.
By the time Republican Rep. Kat Cammack arrived at a Florida emergency room, she was facing an urgent medical crisis: Her pregnancy, then five weeks along, had become ectopic and now threatened her life. It was May 2024, and though Florida's new and particularly restrictive six-week abortion ban did allow abortion in cases like hers, Cammack said she spent hours convincing hospital staff to administer the standard treatment for ending nonviable pregnancies. Doctors expressed fears about losing their licenses, prompting Cammack to pull up the legislation on her phone to show them that her case fell within legal parameters.
Now pregnant again, Cammack recently described her experience to the Wall Street Journal, accusing the political left of 'fearmongering' and creating confusion among health care providers that ultimately puts patients at risk. Her view — that confusion stems from abortion rights advocates, not the laws themselves — has become a rallying point for anti-abortion leaders.
Christina Francis, the head of the American Association of Pro-Life Obstetricians and Gynecologists, blames mainstream medical groups like the American College of Obstetricians and Gynecologists (ACOG) for misleading doctors about when they can provide abortions in states with bans.
'They've…stated that doctors couldn't intervene in those [life-threatening] situations or they would face prosecution, and in fact, they're still peddling that lie,' she told Vox. 'They [just] put out posts on the anniversary of Dobbs saying the same thing, and they have a 'Blame the Bans' campaign where they're actively lying to practicing physicians and telling them that they have to wait until their patient is actively dying.'
But doctors argue they're scared for good reason. The laws create genuine legal risk in complex medical situations, particularly when state officials contradict the courts' interpretations of medical exceptions. That uncertainty played out dramatically in late 2023 in the case of Kate Cox, a Texas woman whose pregnancy developed fatal fetal abnormalities; a judge ruled the law's exception permitted her abortion, but the state's attorney general threatened to prosecute any doctor who performed the procedure. (Cox ultimately crossed state lines to end her pregnancy.) Other high-profile cases of doctors hesitating to provide emergency care have surfaced in the media, adding significant pressure on anti-abortion lawmakers who insist there's no legislative ambiguity to be found.
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Partly in response, red state lawmakers have been moving to address — or at least signal they're addressing — gray areas in their laws, passing 'clarifications' to give doctors more concrete guidance on when they can provide emergency abortions and how criminal penalties would kick in. The Guttmacher Institute found that this is one of the top legislative trends for reproductive health care this year, with 42 bills introduced across 12 states. Three of those bills — in Texas, Kentucky, and Tennessee — were signed into law, and Texas's took effect earlier this month.
Most Americans — across parties, genders, and regions — favor allowing abortion when the pregnancy endangers the mother's life or results from rape or incest, and strong majorities also back exceptions for severe fetal anomalies or serious health problems. All state abortion bans currently include exceptions to 'prevent the death' or 'preserve the life' of the pregnant patient, and many also include some sort of health exception, typically to prevent 'permanent' damage to a 'major' bodily function. The new clarification bills could help prevent the death of some patients but do little to expand access to some of the abortion exceptions voters support.
Clarifying laws that were supposedly clear
The new bills proposing amendments to abortion bans are fueling debates over whether incremental improvements are worth the risk of creating false confidence that major legal obstacles have been resolved. This year's fight in Kentucky clearly captured that disagreement.
The state's local ACOG chapter helped craft the legislative language and supported the proposed clarification bill, calling it an 'acceptable short-term solution.' However, the national ACOG organization, along with Planned Parenthood and some OB-GYNs with Kentucky Physicians for Reproductive Freedom, successfully urged Gov. Andy Beshear, a Democrat, to veto it. 'Although supporters of House Bill 90 claim it protects pregnant women and clarifies abortion law in Kentucky, it actually does the opposite,' Beshear declared. (The legislature overrode the governor's veto two days later.)
As confusion mounts, supporters of abortion restrictions have doubled down on the argument that this is really not a big deal. Francis, the head of the anti-abortion OB-GYN group, argues that the bans are clear and don't need to be rewritten — doctors simply need better education. 'So many of these state laws have been in place for either three years or close to three years, and there's not been a single doctor prosecuted for intervening when a woman's life would be in danger,' she said.
But Francis also acknowledged that physicians were left without reliable guidance from hospitals, state agencies, and professional associations, institutions with attorneys who are themselves uncertain. A Washington Post investigation from late 2023 found that hospital lawyers and compliance teams often hesitated to advise doctors definitively, leaving physicians unsure when and how they could legally act.
Some anti-abortion leaders have gone so far as to allege that physicians are deliberately withholding abortion care to make a political point. Attorney General Jonathan Skrmetti of Tennessee argued it wasn't his state's ban that was harming women, but 'other factors like doctors' independent choices not to provide permissible abortions.'
Still, even as conservatives double down on their accusations of fearmongering, Republican-led states have been quietly adjusting their laws to ease doctors' fears of being prosecuted for providing emergency care.
Utah lawmakers rewrote their emergency exception so doctors do not need to wait for an 'immediate' threat to a patient to provide an abortion. Some states, like Idaho, have moved to scrap their 'affirmative defense' provisions — meaning doctors would no longer have to be charged with a crime first and then prove in court that the abortion was medically necessary. Tennessee moved this year to provide specific examples of what constitutes a permissible exception, including PPROM (the rupture of fetal membranes before 24 weeks of gestation), severe preeclampsia (a high blood pressure disorder), and other infections risking uterine rupture.
Texas's changes to its abortion law took effect on June 20. Its legislation, like Utah's, clarifies that doctors can perform abortions when a pregnant patient faces a life-threatening condition caused or worsened by pregnancy without waiting for that risk to become 'imminent.' The law also standardizes the definition of 'medical emergency' across various state statutes, and it requires training for doctors and lawyers to learn more about these exceptions.
'We all thought it is important that the law be crystal clear,' state Sen. Bryan Hughes, who introduced Texas's clarification bill this year, said in the legislature. Last fall he defended his state's abortion ban, which he also authored, as 'plenty clear' and blamed news organizations for muddying the waters.
The new Texas bill was backed by the Texas Medical Association, the Texas Hospital Association, and leading anti-abortion groups like the Texas Right to Life. Susan B. Anthony Pro-Life America, one of the largest national anti-abortion lobbying groups, praised the passage of Texas's law, stating it will 'end the confusion caused by the abortion lobby through direct education to doctors.'
Susan B. Anthony Pro-Life America also championed a South Dakota law passed last year that required the state to produce a video on how doctors can legally perform abortions to save the life of a pregnant woman. In the state's subsequent six-minute video, the South Dakota Department of Health secretary says a patient does not need to be 'critically ill or actively dying' for a doctor to end a pregnancy. (Abortion rights supporters have blasted the video, which they say provides no real guidelines or legal clarity to practicing physicians.)
Some legal advocates for abortion rights warn the reforms will fail to resolve the underlying confusion.
The bills are 'not to clarify anything. This is just so politicians can say they fixed it,' Molly Duane, a senior attorney at the Center for Reproductive Rights, told Vox. 'The reason I know this is because the anti-abortion lobby has been pretty open about the fact that they were the ones drafting the bills. For a lawyer like me that spends all day, every day, looking at these, it's quite obvious that there's no additional language here that addresses the questions the doctors actually have.'
ACOG also opposed Texas's bill, and the group's general counsel Molly Meegan wrote last month that 'the solution to a bad law is not to further legislate that law. It is to get rid of the law.'
The tough choices abortion rights supporters face
One of the hard realities abortion rights advocates face is that in order to secure more legal protection for physicians working under vague abortion bans, they often must accept language crafted by anti-abortion lobbyists that could make things worse in the future. That controversial language can limit what types of procedures get classified as abortion or can introduce ideological terms like 'maternal-fetal separation,' which are not standard in mainstream medical practice and can help justify or require medical alternatives to abortion, like cesarean deliveries and inductions of labor, that carry greater risk for patients.
While such semantic distinctions may offer doctors some short-term legal protection, activists warn they risk reinforcing a false moral hierarchy between 'good' and 'bad' abortions and stigmatize some forms of care rather than helping the public understand that all these procedures fall under the same broader category of abortion.
Some of the bills also codify new 'fetal personhood' language, which is part of an effort to extend constitutional protections to embryos. Abortion advocates warn this sort of language could help anti-abortion lawmakers strip patients and doctors of additional rights down the line. Beshear echoed these concerns in his veto announcement, blasting the clarification bill for using 'new definitions that have been advanced by advocates who oppose in vitro fertilization and birth control.' He warned that using such language sets 'a stage for future legislation and litigation' that put health care options at risk. Many physicians say they do not feel reassured by these clarifications. If anything, they feel more confused and nervous.
The push for clearer laws reveals a fundamental tension: Abortion rights advocates say exceptions like 'ectopic pregnancy' with no further detail are too vague, yet also argue that the practices of medicine are too complex to codify in law. Republican lawmakers point to legislative language granting deference to physicians' 'reasonable medical judgment,' but advocates say that standard is still too open-ended. More precise language might help in typical cases but risks excluding the edge cases where doctors need protection most.
Given these trade-offs, abortion rights supporters are left grappling with a basic strategic question: whether imperfect progress is worth the potential costs.
'I think that's the age-old question,' said Kimya Forouzan, a state policy researcher at the Guttmacher Institute, which has been tracking legislative trends. 'If one person could get help getting an abortion that's great but at the same time these [clarification] bills are not causing the problem that abortion bans create to go away.'
Sarah Osmundson, a maternal-fetal medicine physician in Tennessee, captured the challenge of working with patients facing high-risk pregnancies in a state with a strict abortion ban. Writing in the New York Times in 2023, she explained why she supported modest changes to her state's abortion ban, even as she understood the arguments of fellow abortion rights supporters that such imperfect amendments come with risks. 'I worry that reproductive rights advocates may be digging into untenable positions and failing to listen to those affected most by the current reality,' she wrote. 'Do we support incremental changes that provide minimum safety for pregnant women and physicians?'
Ultimately, lawmakers drafting clarification bills have been careful to not expand access to care in any significant way. Many still exclude abortions for rape and incest — despite polling showing that majorities of Americans want those carve-outs — and almost no state allows abortion for mental health reasons, despite mental health conditions accounting for over 20 percent of pregnancy-related deaths in the US. Many European countries permit mental health as an acceptable health exception to abortion bans.
Looking ahead, Americans should expect to see more incremental legislative tweaks coupled with state-mandated training, as anti-abortion leaders hail the passage of such medical education, or 'med ed,' laws. Whether this strategy proves durable may depend on how much evidence accumulates that the core problems — criminal penalties, prosecutorial discretion, hospital risk management — run deeper than confusion about legal language.
The med ed campaigns represent an acknowledgment that something needed fixing. The remaining question is this: What happens when the fixes don't fix it?