As we approach the one-year anniversary of Dobbs v. Jackson, the Supreme Court decision that marked the fall of Roe and the end of federal protections for abortion, Vogue is taking a look at the landscape surrounding reproductive rights.
“It was the most twisted feeling, hoping that my daughter wouldn’t have a heartbeat,” says Dani Mathisen, MD, a 26-year-old ob-gyn resident. At the time, Mathisen was 18 weeks along and an anatomy scan had just revealed that the fetus had multiple anatomical defects: problems with the heart, kidneys, spine, and brain.
When Mathisen found out her baby would not survive, she was living in Texas, which has some of the most restrictive abortion laws in the country. SB 8, the so-called Texas Heartbeat Act that took effect on September 1, 2021, and holds even in cases of rape and incest, bans abortions after about six weeks—before many women know they are pregnant—once cardiac activity is detected. (It’s not until roughly 17 to 20 weeks, when the four chambers of the heart have developed, that the term heartbeat is medically accurate, according to the American College of Obstetricians and Gynecologists.)
Mathisen says that she knew her “daughter would ultimately die, whether it was in utero or shortly after birth.” However, because the fetus still had a strong heartbeat, her doctor and maternal fetal-medicine specialist were not only unable to provide care, they were “unable to recommend where to go, what to do, or who to call to terminate the pregnancy,” she says. “I turned to Google because I knew no doctor in Texas would talk to me.”
Mathisen’s experience is not unique. Though it is difficult to quantify how many women terminate for medical reasons (TFMR), the number who have had to deal with complex situations has almost certainly increased since the fall of Roe. (Approximately 1 in 4 pregnancies results in miscarriage and 1 in 100 in stillbirth; it’s estimated that less than 1% of pregnancies lead to conditions that might be considered incompatible with life, however there are no recent statistics on the frequency of TFMR due to a lack of nuanced reporting (and now, post-Roe, fear of legal consequences). TFMR is always a heartbreaking choice—an experience too often shrouded in silence, stigma, and shame. But recent political changes have only intensified the trauma associated with this experience.
Julie, 37, who lives in Birmingham, Alabama, and asked—like several of the women profiled in this piece—that we only use her first name, found out her baby was “incompatible with life” just a week after Roe was overturned. Her genetic counselor informed her she’d need to travel out of state if the diagnosis wasn’t fatal. “Our heads were spinning. We still didn’t even know what was wrong with our baby girl. We didn’t want to think about the law at a time of panic and tragedy,” she says. “We initially made the decision to carry to term despite knowing she would die. But as we got more information about her diagnosis and my health, we made the decision to deliver early at 17 weeks,” she says. “No one can prepare you for the level of trauma and grief.”
Confusion around Alabama laws post-Roe only added to the emotional turmoil, she says. Ultimately, her insurance company confirmed it was legal for her to deliver early in Alabama and covered the cost of the procedure. “Thankfully we did not have to travel or pay out of pocket, but we still had all the co-pays—plus $4,000 for a funeral plot to bury her here,” she says.
Blair Nelson, 36, was 16 weeks along when she found out her baby boy had limb-body wall complex—a rare condition with an extremely low survival rate. She lived in Texas and was told she could travel out of state to try to obtain an abortion or “wait out my baby’s inevitable death sentence.” After a month, she was able to obtain an appointment in Colorado for a dilation and evacuation, the procedure that accounts for the majority of second-trimester abortions in the United States.
“Having to travel makes an already traumatic loss all the more traumatic,” says Jane Armstrong, LCSW-S, PMHC, a clinical social worker certified in perinatal mental health. The emotional and logistical preparation it takes to cross state lines “often extends the torturous limbo period between a decision to end the pregnancy and the procedure itself, which many TFMR parents identify as the most difficult period of their loss,” Armstrong says. “It can also add to the sense that these parents are doing something wrong or bad, when in fact they are doing the least worst thing they can, inside of an absolutely impossible situation.”
Lucy, 31, who received a fetal diagnosis of Klinefelter syndrome when she was 15 weeks pregnant, felt “lucky” to live just 20 minutes away from the only Planned Parenthood in Minnesota that offers abortions—where, she says, she was treated as she “wanted to be, as a mourning mother.” Still, she continues: “The impact of Roe was not lost on my spouse and I as we walked through the parking lot seeing license plates from all over the Midwest.”
Mathisen—the 26-year-old ob-gyn resident—was eventually able to get an appointment in New Mexico, which meant taking time off work and borrowing money from family to book last-minute hotels, flights, and a rental car. “I was alone in a clinic full of strangers in a state I have never been to,” she says. Even in an abortion-friendly state, there were still protestors waiting outside the clinic begging her to “reconsider.”
Mathisen kept her D&E secret for six months, until she eventually went public with her experience in an Instagram post the day after Roe was overturned—an attempt at disbanding the omnipresent stigma. In addition to experiencing depression, anxiety, night terrors, PTSD, and fear for her safety, the possibility of having to terminate for medical reasons again has left her “too scared to have another pregnancy,” she says. “My heart couldn’t handle it again.”
The fear of future pregnancies is shared by many women who have terminated for medical reasons in this post-Roe world. “I am terrified to try again. Terrified this will happen again. Terrified that I may have to travel again if something goes wrong with a pregnancy. And terrified I won’t have another chance at motherhood,” Nelson says, adding that the experience left her with incapacitating anxiety and depression from the trauma of not only losing her baby but nearly losing her life from hemorrhaging during the procedure. (It’s worth noting that this is rare, and the abortion-related complication rate is estimated to occur in only about 2% of cases. According to multiple studies, legally induced abortions are actually much safer than childbirth.) Reporting has suggested that those forced to travel for the procedure have sometimes experienced additional adverse health risks.
Those who terminate for medical reasons often feel a sense of ostracization, even by the pregnancy-loss community itself. This has become even more acute since the overturning of Roe. “As a TFMR mom, I feel I am forced to choose to identify as miscarriage or stillborn to be accepted,” says Breanna, 32, a general-surgery resident physician who traveled to New York from San Antonio to terminate her pregnancy after her son was diagnosed with lower-urinary-tract obstruction (a rare fetal condition that occurs when there is a blockage in the urinary tract of a developing fetus) when she was 18 weeks along. “My story would change depending on the person I was talking to and how I assumed they’d react,” Breanna says. “Sometimes it was easier to just say I delivered a stillborn,” she adds. “I do not feel a part of the pregnancy-loss community. I found that my loss is thought to be more of a choice.” Online forums for those who have experienced miscarriage are often peppered with vitriol directed at women who terminate for medical reasons, echoing the sentiment of “you don’t belong here.”
Although the American College of Obstetricians and Gynecologists considers TFMR to be abortion—and new laws often don’t acknowledge any nuance—most women who find themselves in this predicament don’t relate to the term abortion or view their loss as a choice. “Everyone would choose to have a living, healthy baby. We didn’t choose to be in this situation,” Julie says. “There does seem to be a distinction between making the active choice to terminate versus it happening spontaneously,” says Nelson, who created an Instagram community and business for those experiencing infertility.
This stigma surrounding TFMR can have a ripple effect on mental health. Research shows having an abortion is not linked to mental health issues but restricting access is. And while large studies have shown that obtaining an abortion does not increase the risk of depression or anxiety, abortion stigma does. In fact, a 2020 study found that abortion stigma was associated with higher odds of psychological distress, even years later. A 2022 review examining the relationship between stigma and psychological well-being among women who undergo abortion for fetal anomalies specifically noted the intensifying effect of the sociopolitical-legal environment in the US. “The legal restrictions on access to care in the United States on these parents’ experiences cannot be overstated,” says Armstrong.
Breanna crystallizes the burden carried by many women who terminate for medical reasons: “The sense of choice that most see within TFMR is not real. Mothers who experience TFMR wanted so badly to carry to term and hold our babies. But we had compassionate hearts. We carry the pain and suffering of loss so that they know only love.”
Jessica Zucker is a Los Angeles–based psychologist specializing in reproductive health and the author of I Had a Miscarriage: A Memoir, a Movement.