As children in Texas, A and her sister were raped multiple times by their stepfather and his friends before she found she was pregnant earlier this year.
“We both had STDs because none of them used condoms,” A said. Their stepfather stopped sexually abusing them when he found out the sisters were treated at a clinic for sexually transmitted diseases. One of his friends did not.
The sisters fled to a domestic violence shelter when A found out she was pregnant, and managed from there to find abortion pills through a network of underground activists. “If I couldn’t have an abortion, I would have killed myself,” A said. “The man who raped me was a pig, and I did not want to have his baby inside of me.”
Since Roe v Wade was overturned by the US supreme court in 2022, 14 states have passed near-total abortion bans. Ten of those states, including Texas, have no exceptions for survivors of rape or incest. A study published earlier this year estimated that 65,000 rape-related pregnancies probably occurred in states with abortion bans since Roe fell.
While there are no studies on the numbers of rape-related pregnancies in minors since Roe was overturned, young people in states with abortion bans face unique barriers, according to doctors and advocates who spoke with the Guardian.
“States that ban abortions, both with and without rape exceptions, do not have carve-outs for minors,” Dr Samuel Dickman, one of the authors of the study on rape-related pregnancies since Roe fell, said via email. “Many states where abortion care remains legal impose burdensome additional restrictions on abortion access for minors, such as parental consent or notification laws. And of course, the logistical and financial burdens on people trying to get abortions out of state are often worse for minors, who may not have access to transportation or the funds needed to travel and pay for abortion services.”
Eleven states that have banned or restricted abortion since Roe v Wade fell have exceptions for rape and incest – but, as a recent analysis from KFF shows, they are often unworkable in practice due to a lack of abortion providers, requirements that survivors report the crime to police, and strict gestational limits.
Elisabeth Smith, director of state policy and advocacy at the Center for Reproductive Rights, singles out the law enforcement requirement as a particularly onerous barrier. It is well-known that survivors of rape often avoid going to the police out of fear of retribution or inaction; as the KFF study points out, an estimated 21% of sexual assaults are reported. “We know that sexual assault often goes unreported for various reasons; in states where abortion is banned and clinics have shuttered, everyone, including rape and incest survivors, will likely have to travel out of state to get care,” Smith said.
When a minor child is a survivor of incest, it is often the primary caregiver – parent, step-parent or grandparent – that has raped them, Dr Peta-gay Ledbetter, a psychotherapist and former maternity nurse working with low-income populations in Texas, said. That makes it even less likely she or a relative will report the crime to law enforcement.
Ledbetter said she had seen a 10-year old become pregnant after her mother’s boyfriend sexually assaulted her, with the mother’s knowledge. “Her little body was unable to carry the pregnancy, and she started to have a uterine rupture before the fetus was at a viable gestation.” The complications of preterm labor and uterine rupture necessitated a C-section to save the child’s life; the fetus did not survive. “An abortion would have saved this 10-year-old child great suffering and trauma for the rest of her life,” Ledbetter said.
M, the activist who helped A get abortion pills, says that the minors she comes across seeking help have often resorted to unsafe measures to try to induce their own abortions. In 2023, she was contacted by another 16-year-old from Texas who got pregnant after a stranger raped her. “Like other girls I have met, she tried to overdose on borrowed medications,” M said. Forced to carry to term, she quit school and delivered a baby with a heart defect. M says she remains suicidal. “I’ve met at least three other girls who tried everything from drinking bottles of Nyquil and isopropyl alcohol, to taking Fentanyl,” M added. “One of my colleagues had to call the suicide hotline and poison control.”
There is a dearth of literature on the mental health effects of pregnancies caused by rape, says Jennifer Toof, a trauma-informed psychologist based in Pennsylvania who is writing a book about the ethical responsibilities of mental health professionals post-Roe. “We know that rape and incest are significant risk factors for the development of post-traumatic stress disorder and other mental health disorders, particularly for children, so having pre-existing trauma and mental health struggles on top of being forced to carry an unwanted pregnancy to term when someone is still a child themselves is a dangerous combination.”
A sprawling, underground network of activists is trying to fill the gap by providing women and girls with the means to end their pregnancies safely. According to M, who is not sharing her real name given the nature of her work, “we rely on a network of women who live in blue states to keep us ‘supplied’.” These activists often provide support beyond the pills themselves – M told the Guardian that they also provide funds and help minors travel for the care they need.
Tightening restrictions
The impact of abortion bans on young rape survivors came into national focus in 2022, when a 10-year-old girl from Ohio who was pregnant as the result of a rape was forced to travel to Indiana for an abortion, as her home state banned the procedure after six weeks. (Abortion rights have since been codified in Ohio’s constitution.) The Indiana doctor who performed the abortion, Caitlin Bernard, reported the procedure as required by state law, sparking a campaign against her by a group of anti-abortion activists and politicians.
In another highly publicized case, in Mississippi, a 13-year-old girl who was raped by a stranger when she was 12 got pregnant and had to carry the baby to term because her family didn’t have the money to drive to the nearest abortion clinic in Chicago, or to pay for the procedure. While the child and her mother reported the rape to law enforcement, she was unable to terminate the pregnancy due to a lack of clarity around the exception. Today, she is raising the baby with the help of her family; her rapist was caught and charged.
Some lawmakers have tried to introduce carve-outs to abortion bans for minors but have faced pushback in conservative states. In May 2024, a legislative committee in Louisiana rejected a bill that would have added cases of rape and incest as exceptions to Louisiana’s abortion ban. They also rejected an amendment brought by the Democratic state representative Delisha Boyd, which would have narrowed the bill to apply only to minors under the age of 17.
Other states are seeking to make it even harder for children to access care. Laws in Idaho and Tennessee seek to punish any adult who helps a minor cross state lines for an abortion.
Such laws are “falsely presented as ‘parents’ rights’ measures”, says Alison Brysk, a political science professor at the University of California, Santa Barbara, who researches the politics of abortion. “This means that the access to abortion for a child impregnated by parental abuse could depend upon the permission of the very person who abused them.”
Information and support for anyone affected by rape or sexual abuse issues is available from the following organisations. In the US, Rainn offers support on 800-656-4673. In the UK, Rape Crisis offers support on 0808 500 2222. In Australia, support is available at 1800Respect (1800 737 732). Other international helplines can be found at ibiblio.org/rcip/internl.html
