Abortion Debate Shifts to Pregnancy and Fertility as Election Nears

In the decades that Roe v. Wade was the law of the land, abortion rights groups tried to shore up support for it by declaring “Abortion Is Health Care.”

Only now, two years after the Supreme Court eliminated the constitutional right to abortion, and just six months before the presidential election, has the slogan taken on the force of reality.

The public conversation about abortion has grown into one about the complexities of pregnancy and reproduction, as the consequences of bans have played out in the news. The question is no longer just whether you can get an abortion, but also, Can you get one if pregnancy complications put you in septic shock? Can you find an obstetrician when so many are leaving states with bans? If you miscarry, will the hospital send you home to bleed? Can you and your partner do in vitro fertilization?

That shift helps explain why a record percentage of Americans are now declaring themselves single-issue voters on abortion rights — especially among Black voters, Democrats, women and those ages 18 to 29. Republican women are increasingly saying their party’s opposition to abortion is too extreme, and Democrats are running on the issue after years of running away from it.

“When the Dobbs case came down, I told my friends — somewhat but not entirely in jest — that America was about to be exposed to a lengthy seminar on obstetrics,” Elaine Kamarck, a fellow at the Brookings Institution, referring to the Supreme Court decision that overturned Roe v. Wade.

Abortion opponents say that stories about women facing medical complications are overblown and that women who truly need abortions for medical reasons have been able to get them under exceptions to the bans.

Still, a poll in April found that 46 percent of registered voters had heard stories of women forced to cross state lines to get abortions they needed because of pregnancy complications — up 11 points since September. In the latest abortion case before the Supreme Court, justices from both ends of the ideological spectrum pressed lawyers for Idaho to explain how the state could deny the procedure to a woman who was bleeding uncontrollably after her water had broken early.

The Biden campaign has dispatched six women to battleground states as it tries to mobilize voters around Monday’s two-year anniversary of the decision overturning Roe: Five were denied abortions even as they went into septic shock, became unconscious, miscarried or discovered a fetus had no skull; the sixth could not complete her plans to have a second child through I.V.F. after a ruling from Alabama’s Supreme Court shuttered clinics in the state.

Tresa Undem, who has been polling people on abortion for 25 years, estimated that before the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe, less than 15 percent of the public considered abortion personally relevant — women who could get pregnant and would choose an abortion.

“Now it’s about pregnancy, and everybody knows someone who had a baby or wants to have a baby or might get pregnant,” she said. “It’s profoundly personal to a majority of the public.”

In her polls and focus groups, voters relate abortion to concerns about safety, health and medical care. Seventy-three percent of independents who support abortion rights said stories about women almost dying because of bans would affect how they vote.

“People used to talk about politicians trying to control our bodies,” she said. “Now it’s, they have no business getting involved in these medical decisions,these politicians don’t have medical expertise,they’re making these laws, and they’re not basing it on health care or science.’”

Americans have generally been fuzzy on the details of reproduction. When Ms. Undem asked adults in a poll in August 2020 whether it was true that “most women get their period on the first of the month,” 75 percent got the right answer — false — but a notable 21 percent said they were “not sure.” Two months after Dobbs, 22 percent of adults said they were uncertain whether eggs inside a woman’s ovaries have shells (they do not).

But in the last two years, women have increasingly spoken out in public and on social media about pregnancy complications that could have or did end in abortion. Many had stories like that of the model Chrissy Teigen, who in September 2022 announced that she had belatedly realized that the procedure she described in an earlier social media post as a miscarriage at 20 weeks was in fact an abortion because of pregnancy complications.

Anti-abortion groups have responded by trying to carve out a difference between “elective abortion” for unwanted pregnancies — which they want banned — and “maternal fetal separation” in medical emergencies. (The medical procedure is the same.)

“Pro-abortion Democrats resort to fear-mongering to drive their radical abortion agenda, rather than presenting women with the facts they deserve,” said Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America.

Still, the push by anti-abortion activists to establish that life begins at conception has aggravated concerns about how abortion bans affect popular health care procedures. Republicans in Congress rushed to defend I.V.F. this month after the Southern Baptist Convention voted to oppose it. Men and women at the convention begged other church members to support I.V.F., tearfully telling how it had allowed them to grow their families.

Opponents have long stigmatized abortion as something irresponsible women use as birth control or because they care more about their careers than having children. “When the focus shifts to the dangers that abortion bans inflict on pregnant people,” said Reva Siegel, a constitutional law professor at Yale who has written extensively about the country’s abortion conflict, “it’s easier for Americans to talk about.”

It’s not just that stories about pregnancy complications are getting more airtime. Technology and criminal law have flipped the script, she said.

Although abortion is now out of reach for millions of women, especially the poor, those with unintended pregnancies can use home tests that allow them to know they are pregnant earlier, and they can order pills for abortion online.

But for women with pregnancy complications, there are new hurdles. Before Roe legalized abortion nationally in 1973, the law allowed more leeway for what were considered “therapeutic abortions.” Doctors, often solo practitioners, could use their good faith judgment to provide them. Even the Southern Baptist Convention supported abortions in cases of fetal deformity or when a woman’s physical or mental health was at risk.

Now, the threat of prosecution, $100,000 fines and loss of their medical licenses have chilled doctors and hospital systems in treating women with pregnancy complications. More often than not in some states, lawyers are making the decisions.

“People are starting to realize how much this affects, outside of quote-unquote just abortion care,” said Dr. Nisha Verma, a complex-family-planning specialist in Georgia and a fellow of the American College of Obstetricians and Gynecologists who has testified before Congress.

In Georgia, she said, more people opposed the state’s ban on abortion after six weeks of pregnancy once they were told that this meant two weeks after the average woman misses her period — not, as her own partner believed, six weeks after conception. Some voters, she said, believed that six weeks meant six weeks after women found out they were pregnant.

“We don’t want to raise up only certain abortions as being worthy,” Dr. Verma said. At the same time, she added: “The ‘our body, our choice,’ we did that for a long time, it wasn’t working. Our movement’s historical messaging has a place, but it can be deeply polarizing for people who are struggling with abortion’s complexity, which is a majority of Americans.”