What New Abortion Bans Mean for the Youngest Patients

She was just 10 years old, so young that many people were horrified when they heard it, and others refused to believe it. But the ordeal of the child rape victim in Ohio who had to cross state lines for an abortion, and the ugly political fight that followed, have highlighted two uncomfortable facts: Such pregnancies are not as rare as people think, and new abortion bans are likely to have a pronounced impact on the youngest pregnant girls.

New bans in nearly a dozen states do not make exceptions for rape or incest, leaving young adolescents — already among the most restricted in their abortion options — with less access to the procedure. Even in states with exemptions for rape and incest, requirements involving police reports and parental consent can be prohibitive for children and teenagers.

“The situation out of Ohio is in no way unique,” said Katie McHugh, an OB-GYN in Indiana and board member of the group Physicians for Reproductive Health, which favors abortion rights. “This is a situation that every abortion provider has seen before.”

The number of pregnancies in the United States among girls under the age of 15 has fallen sharply in recent decades with greater access to contraception and a drop in adolescent sexual activity. But state and federal data suggest there are still thousands of such cases each year. And nearly half of these pregnancies end in abortions, according to the Guttmacher Institute, which supports abortion rights and surveys clinics regularly.

In 2017, the last year for which data was available, the institute concluded there were 4,460 pregnancies among girls under 15, with about 44 percent ending in abortion. In Ohio alone, 52 girls under 15 received an abortion in 2020 — an average of one every week, according to the state Department of Health.

It is unclear how often these pregnancies are the result of incest or rape. Children in this age group are generally below the age of sexual consent, though sexual contact between two similar-aged young teenagers is not always considered a crime. And some states allow children to marry with parental permission.

In Ohio, sex with a person under the age of 13 is a first-degree felony. Abortion is now banned in the state after around six weeks of pregnancy, with no exceptions for rape or incest.

The startling age of the Ohio rape victim helped propel doubt over her story, which quickly morphed into a political firestorm after it was reported in The Indianapolis Star. Abortion rights advocates and President Biden pointed to the girl’s experience as the tragic consequence of abortion bans. Conservatives questioned whether the child existed, and even the Ohio attorney general initially said he found no evidence of such a victim.

That doctor, Caitlin Bernard, later tweeted, “My heart breaks for all survivors of sexual assault and abuse. I am so sad that our country is failing them when they need us most.”

Lauren Ralph, an epidemiologist at the University of California, San Francisco, said her research shows that adolescents who seek abortion tend to be firm in their choice but face barriers such as lack of transportation, and parental notification and consent laws, which exist in the majority of states. Minors who seek to avoid parental notification, such as in the case of incest or when a parent would seek to compel pregnancy, are often required to file a police report or appear before a judge.

Those are high and sometimes impossible bars to clear, experts said, especially for individuals without legal assistance, and young victims who may have been hurt by the adults closest to them.

With some Americans living up to 400 miles away from the nearest legal abortion provider, the new state bans stand to affect teenagers severely.

“We know that young people already faced many more barriers to accessing abortion prior to the decision to overturn Roe v. Wade,” Dr. Ralph said. “What will happen with this decision is that those barriers for young people living in restricted states will now multiply.”

Dr. Bernard, the Indiana OB-GYN who provided an abortion for the 10-year-old Ohio girl, said in an interview in early July, before the political firestorm erupted, that she had experience treating other very young rape victims.

The hardest case of her career, she said, was one where a mother brought her 14-year-old daughter in for an appointment after the girl was raped. The mother wanted her daughter to have an abortion.

“But the patient said, ‘I don’t want to kill my baby,’” Dr. Bernard recalled. “She felt as though abortion was wrong.”

Dr. Bernard said she told the mother that she could not perform the abortion without the 14-year-old’s verbal consent. Eventually, the mother persuaded her daughter to undergo the procedure.

Indiana, which currently allows abortions at up to 22 weeks, may enact its own stricter limits soon in a special legislative session scheduled for late July.

In Oklahoma, a law that bans nearly all abortions makes exceptions for cases of rape or incest, but only if those crimes have been reported to law enforcement.

Wendi Stearman, the Republican legislator behind that Oklahoma law, defended high barriers for exceptions.

As for the 10-year-old in Ohio, “It’s horrific, what happened there,” she said. “But even more horrific is taking the life of another child.”

Ms. Spearman said laws should not cater to worst-case scenarios.

“Laws should be made for the general, and that is an incredibly rare instance,” she said.

It is not uncommon for some anti-abortion lawmakers and organizations to oppose rape exceptions to abortion bans, sometimes even in the case of child victims. In a statement praising the arrest of a 27-year-old suspect in the Ohio case, Ohio Right to Life expressed concern for the young girl and her family but called her abortion a “band-aid solution” that “only added to the pain and violence perpetuated against her. The victim deserved better.”

Kristan Hawkins, president of Students for Life of America, said, “The violence of rape will not be cured by the violence of abortion. The love and support that this child needs will be ongoing, not momentary.”

Yet abortion providers and doctors who care for the youngest patients say that approach fails to recognize the needs and desires of young victims and their families.

In Colorado, Kristina Tocce, medical director for Planned Parenthood of the Rocky Mountains, said she had provided an abortion to a 13-year-old incest victim and had recently treated her youngest patient ever: an 11-year-old Texan who flew to Denver for an abortion alongside a parent. Though that patient was treated before Roe was overturned, the child was forced to leave Texas because the state had found a legal workaround to ban abortions after six weeks of gestation, without exceptions for rape or incest.

It was the 11-year-old’s first time on an airplane, Dr. Tocce said.

In Texas, state records show over 200 children aged 15 and younger received abortions in 2021, before the ban was passed. One of those patients was 11 or younger, and 30 were 12 or 13 years old.

Dr. Tocce predicted an influx of patients in Colorado, where abortion remains legal without a gestational limit. Even in states that allow for the procedure in cases of rape or incest, the burden of proving that patients qualify for an exemption may intimidate providers, who will not want to risk prosecution, she noted.

“Those exceptions are in print, only they essentially mean nothing when everyone who practices there is too afraid,” she said.

In Madison, Wis., Jennifer Ginsburg, executive director of the Safe Harbor Child Advocacy Center, said she was saddened but unsurprised to hear the story of the Ohio victim.

Just a few months earlier, her center, which works with victims of child abuse, had referred a 10-year-old girl, impregnated by her stepfather, for an abortion at Planned Parenthood.

Ms. Ginsburg and her team provide counseling and support for young abuse victims and their family members, while also ensuring that any forensic evaluations conducted for police investigations do not compound a child’s trauma. If a victim wanted an abortion, the center would help connect them to nearby providers.

But shortly after the Supreme Court overturned Roe, doctors in Wisconsin halted abortion services. Gov. Tony Evers, a Democrat, is battling Wisconsin’s Republican-led Legislature over the validity of a century-old law that criminalizes nearly all abortions, including those that are the result of rape and incest. Mr. Evers and his attorney general have filed a lawsuit in an attempt to block the ban.

Ms. Ginsburg said Safe Harbor was not waiting for the results of the governor’s suit. She was planning with other local organizations to assist young victims in traveling out of state for an abortion — a plan that advocates are increasingly turning toward as more states outlaw the procedure.

“How are we going to help the pregnant kids?” she asked.

Margot Sanger-Katz contributed reporting.