Stop calling it a six-week ban
It’s a total abortion ban
On January 4, Iowa’s medical board met to hear public comment on the total abortion ban, which was passed into law last July in a special legislative session.
A judge passed a temporary injunction on the ban a week after the bill was signed. But the process for implementation of the law, which now rests with the Iowa Board of Medicine, is still moving forward. And last week’s hearing was the final step before the board moves to vote on administrative rules to enforce the ban.
You will notice I called it a “total abortion ban” instead of a “six-week ban.” While the bill technically bans bills after six weeks or whenever a “fetal heartbeat” can be detected, what it amounts to is a total abortion ban.
While watching coverage of Iowa’s law and similar laws around the nation, I noticed almost rigorous adherence to calling these bills “six-week bans.” I understand why. Journalists are generally required to use specific wording for anything considered sensitive or controversial. And yet, the term “six-week ban” is deeply misleading.
Legally, a six-week ban prohibits abortions when a fetus is at six weeks of gestation. But one recent study found that one-third of American women don’t find out they are pregnant until they are six weeks pregnant. One in five found out at seven weeks or later. In a 2018 study, researchers found that the average gestational age of a fetus at the time of pregnancy detection was 5.5 weeks and that the detection age hadn’t altered much over time. Essentially, many pregnancies are discovered at or about six weeks, meaning that for a large portion of pregnant people a six-week ban amounts to a total abortion ban.
And the phrasing matters. Banning abortion is deeply unpopular. Sixty-one percent of Americans believe that abortion should be legal in all or most circumstances. But there is a lot of disagreement on when in a pregnancy abortion should be legal and under what circumstances. According to a 2023 Gallup poll, “When asked about the legality of abortion at different stages of pregnancy, about two-thirds of Americans say it should be legal in the first trimester (69%), while support drops to 37% for the second trimester and 22% for the third. Majorities oppose abortion being legal in the second (55%) and third (70%) trimesters.”
Lawmakers pass legislation like a six-week ban under the guise of being reasonable and responsive to their constituents. But the reality is just the opposite. In practice, these bills are nearly blanket bans and are resulting in the pain and injury of pregnant people across the United States.
We’ve seen this false marking with abortion bills that have “exceptions” for rape and incest. But those exceptions rarely work in practice. Rape and incest are under-reported. And poorly written bills create legal gray areas that require doctors to become lawyers when it comes to defining those terms. Doctors are risk-averse. And even people who do qualify under exceptions for the health and safety of the mother have a hard time accessing the care they need. Most notably in Texas, where Kate Cox, a mother of two, had to flee the state for an abortion. The Texas Supreme Court ultimately decided that despite doctors declaring her abortion medically necessary, she could not have one in the state. Also in Texas, the Fifth Court of Appeals recently ruled that a law requiring ER doctors to care for patients doesn’t include abortions.
Chris Geidner of Law Dork summarizes the ruling succinctly. “The ruling means that if a doctor in a Texas emergency room decides a person needs an abortion to stabilize them and it would not be allowed under Texas’s more-limited exceptions to its abortion ban, Texas law controls and the abortion is banned.”
Additionally, the term “fetal heartbeat bill” is misleading because fetuses don’t have heart valves at six weeks — what the ultrasound machine picks up is merely electrical activity and that’s an important distinction. Calling a piece of legislation a heartbeat bill suggests that a six-week old fetus has a heart, which it doesn’t. But that image is a powerful one that creates public concern over a baby with a heart rather than a fetus with electrical activity.
And it’s not pedantic or incorrect to insist that reporters and pundits call a six-week ban a ban. It’s a public service to use correct language that accurately reflects the effect of the law. Because in the world of women’s healthcare we are fighting a war of misinformation. As Jessica Valenti pointed out in the New York Times, when faced with story after story of women fighting for abortions to save their own lives, anti-abortion groups and politicians are trying to soften their messaging on abortion.
“But rather than change the policies that are causing so much suffering, conservatives seem to believe they can talk their way out of the problem not just with political messaging but also by manipulating medical and legal language.”
She points to comments by Donald Trump and Ron DeSantis about “post-birth abortion,” which is literally not a thing that happens. But that doesn’t stop people from believing that it does.
And using correct terms is necessary because their absence creates confusion. For example, the Iowa bill requires a trans-abdominal ultrasound to determine whether a “heartbeat” can be detected. But currently in medical practice a trans-abdominal ultrasound is not the standard of care in pregnancy. Many of these abortion bans use language like “pregnant women” and “unborn child” which can create legal confusion with medical professionals. When is a fetus an unborn child? Is a trans man who is pregnant allowed to get an abortion?
Also, as Iowa journalist Laura Belin points out on her website, “The proposed administrative rules require doctors to put a signed certification in the woman’s medical records containing the following information: ‘...The basis for the diagnosis, including the tests and procedures performed, the results of those tests and procedures, and why those results support the diagnosis; and a description of why the abnormality is incompatible with life.’”
Belin explains, “Doctors rarely deal in such absolutes. Some medical conditions cause certain death outside the womb. But what if an infant could survive for a few minutes, hours, or days after birth? What if reasonable physicians could reach different conclusions about whether the abnormality is survivable? What if the condition is usually lethal, but might be survivable 5 percent or even 1 percent of the time?”
When our medical realities and political language fail to connect, people die.
Further reading:
The absurd math of six-week bans.
Women are dying via Jessica Valenti
I've done a lot of work on the briefs to block and overturn this nonsense thru the courts. Let me add what a total joke the rape "exceptions" are and how this bill puts survivors of sexual and domestic abuse at even greater risk. The law only considers "incest" between blood relatives. It is unclear if it would include step-fathers or step-brothers. The rape must have been "reported within 45 days" (or within 140 days for incest) but there is no definition of what constitutes a report. What about a person who was roofied and doesn't even know until much later that she was raped? Not to mention that the abortion law uses the term "rape" even though there is no definition of rape anywhere in the Iowa Code.
Abusive partners commonly use pregnancy as a form of entrapment; they know that a child will give them permanent connection and control over someone. Over half of women in family planning clinics reported physical or sexual partner violence, 19% reported pregnancy coercion, and 15% reported birth control sabotage. One third of respondents reporting partner violence (35%) also reported reproductive control. (Miller E, Decker MR, et al. Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception. 2010 Apr;81(4):316-22.) In the United States, homicide by an intimate partner is the leading cause of death among pregnant women.
Obviously, I have big feels about this. In the meantime, everyone should have emergency contraception on hand just like bandaids and other first aid. Be that friend, be that auntie.
This is in the linked piece about the absurd math of six-week bans and I think it's worth highlighting:
"The reason pregnancy math works so strangely is practical: it’s easier to pinpoint the first day of someone’s last period and count from that point as a standard marker because dates of ovulation and conception are harder to identify. But counting pregnancy as beginning during the last period includes two weeks prior to actual pregnancy and can inspire public health policy considering all women of reproductive age to be 'pre-pregnant,' such as health messages that recommend that all women of reproductive age abstain from alcohol. Given a lack of adequate education in health and biology—educational information that is often another target for evangelical Christians—some may think 'six weeks of pregnancy' is plenty of time to realize you are pregnant. But at only four weeks post-conception, and three weeks post-implantation, there is a limited window to even affirm pregnancy."
Six weeks *includes* the roughly two weeks before conception can occur and the remaining four weeks are barely enough to consistently/reliably detect a pregnancy with a home test. So if the six-week clock starts before conception and ends before you might even know you are pregnant it's a total ban.