Intended for healthcare professionals


Alabama law makes almost any abortion a crime

BMJ 2019; 365 doi: (Published 16 May 2019) Cite this as: BMJ 2019;365:l2232


New efforts to restrict abortion in the United States

  1. Owen Dyer
  1. Montreal, Canada

Doctors who perform abortions in the US state of Alabama would face from 10 to 99 years in prison under a new law that bans the procedure at all stages of pregnancy, including in cases of rape or incest. Exceptions will only be allowed if the mother faces a “serious health risk” from continuing the pregnancy or the “unborn child has a lethal anomaly.”

The bill passed the Republican dominated state senate by 25 votes to six. All of those voting for it were male Republicans. Only four of Alabama’s 35 state senators are women, and all of them are Democrats.

Alabama’s Republican governor Kay Ivey is expected to sign the bill. It will probably then face a swift challenge in the courts, where such strict anti-abortion laws have been struck down repeatedly.

But this is actually the bill’s real purpose, according to its authors and to women’s rights advocates, who say the Alabama law is one of a flurry of recent bills that are designed to kickstart litigation that will end up before the US Supreme Court.

Conservatives hold a majority on that court since the controversial appointment of Donald Trump’s nominee Brett Kavanaugh, and abortion opponents hope a legal fight could end with the overturning of Roe v Wade, the landmark 1973 decision that made abortion legal across the country.

Another such bill was signed into law last week in Georgia, banning abortion from the moment when fetal cardiac activity can be detected—as early as six weeks after conception, at a point when women may not yet know they are pregnant.

Georgia was the fourth state this year to pass what supporters call a “heartbeat bill,” although embryos do not have heart chambers at six weeks and are only considered fetuses by mainstream medical science at nine weeks. The other states were Kentucky, Mississippi, and Ohio.

Also considering such bills are the Republican legislatures of Florida, Louisiana, Missouri, South Carolina, Tennessee, Texas, and West Virginia.

Conservatives’ hopes of overturning Roe v Wade are still some distance from realisation. Any case would take at least two years to pass through the lower courts.

The Supreme Court’s swing vote is generally seen as Chief Justice John Roberts, the most moderate of the five Republican appointees on the bench of nine judges. He has ruled to restrict abortion rights in the past, but has also signalled his concern that increasing perceptions of partisanship could undermine the court’s legitimacy.

A Fox News poll in February showed that Americans are broadly opposed to overturning Roe v Wade. Some 57% of respondents supported keeping Roe v Wade while just 21% wanted it overturned. Among those who said they were familiar with the ruling, the split was 68% for it and 26% against.1

The two parties were sharply divided on the matter, but even among Republicans, more wanted to keep the ruling (43%) than overturn it (37%). Majorities of both men (54%) and women (59%) were in favour of keeping Roe v Wade.

Women’s rights campaigners in the UK were quick to point out that even Alabama’s new abortion law is not as strict as the 1861 law barring abortion in Northern Ireland, which threatens not only doctors but pregnant women with life imprisonment if they undergo the procedure.