In states that allow abortion for rape and incest, finding a doctor may be impossible.

Abortion clinics and foundations in Idaho, Mississippi, North Dakota, and Wyoming—four states with rape or incest exceptions to abortion bans—told POLITICO that while the law may allow people to terminate pregnancies in such cases, it is likely it will be easier to get patients across state lines for abortions than trying to overcome the hurdles of legally obtaining an abortion in their home state.

“In theory, [exemptions] Sounds great, but in practice it seems impossible,” said Tammy Kromenaker, director of the Red River Women’s Clinic in Fargo, North Dakota. “My doctor would never agree to this. She simply said: “Let’s throw all the money and resources on this person.” Let’s take them somewhere else where it’s legal.”

Clinics planning to move their operations out of state may leave patients in their states without health care providers willing to offer abortions for cases of rape and incest. Willing suppliers like Anthony can be dissuaded for fear of prosecution. And patients may not want an abortion if their state requires them or their provider to report rape or incest to the police, as is the case in Idaho, Utah, and Mississippi.

“There is still so much fear and stigma and shame in it,” Kromenaker said. “Sometimes patients say, ‘I thought if I told you, you would make me report this to the police, and I don’t want to do that.’ It’s someone I know.”

BUT survey published by Pew Research Center found in May that 56 percent of Republicans and 83 percent of Democrats thought abortion should be legal if the pregnancy was the result of rape. But abortion rights advocates warn that so few people will be able to take advantage of the exceptions, that it will be as if they don’t exist.

Exceptions are just a way for Republicans to say, “Well, don’t worry now, we’re introducing this ban, but when you need your ‘good abortion’, access will be yours,” but that’s all bullshit. It won’t be there for you,” said Lori Bertram Roberts, executive director of the Yellowhammer Foundation in Alabama and co-director of the Mississippi Reproductive Freedom Foundation. “If you consider yourself one of the “good people” who only need an abortion in a “good case” – baby, they have already come for you. And they won’t give you an abortion.”

Some Republicans, however, argue that exemptions remain a lifeline for people in crisis.

Arkansas Gov. Asa Hutchinson, a limited-term Republican in his senior year, told CNN last month that he supports exceptions for rape or incest, although the abortion ban he signed in 2019 does not include such exceptions. At the time, he said he hoped the matter would be “revisited,” though he said Friday he would not ask lawmakers to bring exceptions to a special session.

“Although it is still life in the womb, the life of the unborn, the conception occurred under criminal circumstances, whether it was incest or rape,” he said. “So those are two exceptions that I found very appropriate.”

While exemptions may only have a limited impact, they will be critical to the people who can get them, although “there will be very, very few statistically,” said Iris Alatorre, program manager for the Northwest Abortion Access Foundation. which covers Idaho.

Exceptions due to rape and incest are increasingly at odds among legislators. Several Republican Senate candidates, including Herschel Walker in Georgia and JD Vance in Ohio, have spoken out against rape and incest expulsions in recent weeks, despite the fact that many of their potential peers continue to support such exceptions. GOP gubernatorial candidates split on the issue.

And the governor of Louisiana. John Bel Edwards, Democrat supporting abortion restrictions, on Tuesday signed the measure passed by the Republican-controlled state legislature, which does not allow abortion in cases of rape or incest, despite his personal support for such exceptions.

Anti-abortion groups also disagree on how to approach the rape and incest exceptions. While Pro-Life America’s Susan B. Anthony believes that “the value of human lives is not determined by the circumstances of one’s conception,” the organization does not take a position on whether state legislators should include rape and incest exceptions in their abortions. bans, believing it’s a matter for each state to decide, said Sue Liebel, group director of public policy.

Meanwhile, Students for the Life of America are urging lawmakers to speak out against such exceptions.

“We refuse to shame children for something that is out of their control,” said group spokeswoman Christy Hamrick. “Obviously, crimes should be fully prosecuted and women should help. But we also mourn for premature babies who are also suffering.”

The Hyde Amendment, which bans federal funding from paying for abortions except in cases of rape or incest, or to save the life of a pregnant woman, gives an idea of ​​how difficult it can be to use post-abortion exemptions.Caviar. According to the Guttmacher Institute, an abortion rights think tank, the federal government paid for 160 abortions for Medicaid recipients in 2015, latest year for which data is available; meanwhile, 18 states used public Medicaid funds to pay for more than 157,000 abortions.

“When we think that Medicaid exceptions have not actually been implemented, it doesn’t seem to allow us to think that exceptions in trigger bans or prior bansCaviar the bans would have been implemented in any other way,” said Elizabeth Nash, a public policy expert at the Guttmacher Institute. “They are designed to be extremely narrow and difficult to enforce, because opponents of abortion see exceptions as a loophole.”

At the Red River Women’s Clinic in North Dakota, about one patient a week reports that she wants an abortion because she was raped, Kromenaker said, and the clinic will apply to the state’s Medicaid program for reimbursement about once a month.

But this is not enough to remain financially viable.

“In order to be able to keep our doors open – and I’m not saying few people have been abused – for people who have been abused, who have become pregnant, who want to reveal it and have an abortion, it would be impossible for us to maintain staff, maintain the facility and everything like that,” Kromenaker said.

Instead, her clinic plans to move five minutes across the river to Moorhead, Minnesota, where abortion remains legal, and Kromenaker hopes patients will follow suit.

For those unable or unwilling to travel out of state, abortion rights advocates anticipate that some OB/GYNs in private practice, such as Anthony, may want to prescribe abortion pills to people who become pregnant through rape or incest.

Abortion rights advocates are also concerned that people seeking an abortion under life or health exceptions may face similar barriers. State bans on abortion vary, with some prohibiting abortion other than “to save the life” of a pregnant woman, while others also contain exceptions “to prevent a serious risk of substantial and irreversible impairment of essential bodily functions”, someone’s health or life must be qualified.

“It feels like this is the conversation going on in this legal, abstract world,” Nash said.

Liebel said she is urging state lawmakers to review and clarify their abortion bans when they next meet.

“I know what I’m advising is that this time if you clear the board and redo – and even if you have exceptions or other things – you’ll have to define it better,” Liebel said. “If it’s still too vague, the case will end up in court.”