Intended for healthcare professionals


Abortion: Indiana becomes first US state to enact an almost total ban

BMJ 2022; 378 doi: (Published 10 August 2022) Cite this as: BMJ 2022;378:o1998
  1. Janice Hopkins Tanne
  1. New York

The US state of Indiana will ban abortions after 15 September 2022 except in cases of rape, incest, fatal fetal anomaly, or a serious risk to the health or life of the pregnant patient. It is the first state to pass such a ban since the Supreme Court overturned Roe v Wade, the 1973 decision legalising abortion, in June of this year.

Indiana is the state where a 10 year old girl, pregnant after rape, was taken for an abortion last month when it was too late for her to be treated in her home state of Ohio.1 A midwestern state with a population of about 6.8 million, it usually votes Republican.

Indiana’s law, known as Senate Bill 1,2 was passed by the state’s senate and house of representatives and signed on 5 August by its Republican governor, Eric Holcomb. He praised the bill as “protecting life.”3

Abortions for a fatal fetal anomaly will be permitted up to 20 weeks post fertilisation and up to 10 weeks in pregnancies due to rape or incest.

A few Republicans voted against the bill because they thought that it did not go far enough. Some of them opposed exceptions for rape or incest, and at least one thought that all abortions should be banned. The Republican representative John Jacob said, “Human life begins at conception. Murder is the taking of a human being’s life. And abortion always take the life of an innocent pre-born human being.”4

No Democrats voted in favour of the bill. The Democratic representative Maureen Bauer said, “Forced birth is not freedom. Indiana’s going to force women and girls to give birth when 50% of our state is a childcare desert. Forced birth in the only wealthy nation that does not provide paid family medical leave.

“Forced birth in a nation where black moms face higher rates of death from pregnancy and childbirth. Forced birth where we average one mass shooting per day and have no universal healthcare or universal childcare.”

Doctors’ licences

The law closes all abortion clinics in the state and permits abortions only in outpatient surgical facilities and hospitals. Telehealth and telemedicine are not permitted. Medication abortion pills must be dispensed in person and taken on site. Healthcare providers must tell pregnant patients that the medication abortion can be reversed if only the first pill (mifepristone) is taken—advice that is not medically accepted.

Abortion for Down’s syndrome is forbidden. Maternal emotional and psychological conditions are not considered risk factors.

Patients must be told about “safe havens” where a newborn can be safely left. A day before the abortion the patient must be able to see an ultrasound of the fetus and listen to its heartbeat. After the abortion the fetal remains are to be interred or cremated.

Doctors must file complex paperwork or face losing their licence. If they perform an illegal abortion they may lose their licence and face a fine and prison sentence. However, they do not face punishment if medical treatment causes accidental or unintentional termination of pregnancy.

The bill also “requires the maternal mortality review committee to study how changes in the state’s abortion laws affect maternal mortality in Indiana and extends the committee until June 30, 2027.”

Indiana’s business community opposed the law, as did all major medical associations. Eli Lilly, one of the state’s largest employers, said that the law would hinder its ability to attract diverse scientific, engineering, and business talent and pledged to “plan for more employment growth outside our home state.”5 Several large companies are offering reproductive healthcare benefits outside Indiana.

The Washington Post has reported that obstetrician-gynaecologists are turning down job offers in states with restrictive abortion laws. Some said that they had rejected offers because they feared that they would lose their licence or be fined for doing their job.6