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Many state abortion bans include exceptions for rape. How often are they granted?
Dr. Emily Boevers, an OBGYN based in Waverly, Iowa, poses for a portrait at her family’s farm in nearby Tripoli. She says the state’s rape exception requirements threaten the privacy, trust and intimacy of the patient-doctor relationship.
Geoff Stellfox for NPR
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Geoff Stellfox for NPR
After the Supreme Court overturned the federal right to abortion in 2022, many states that banned the procedure did so with the promise that it would still be legal in some circumstances, including in the event of rape. One study estimates that over 64,000 pregnancies have occurred due to rape in the years since the ruling in states where abortion is banned.
But many people on the frontlines of this issue say getting an abortion in these states after an assault is difficult or – in some cases – impossible.
There is no central database that measures abortions performed because of rape. For this story, NPR looked at state records and talked with researchers, advocates and doctors in seven of the 11 states where abortion is banned but legal in the case of rape. Taken together, these accounts show a patchwork of laws governing rape exceptions, confusion over who qualifies for an exemption and law enforcement’s role in that process, and widespread fear from doctors about performing abortions for assault victims.
Many victims aren’t capable of immediately reporting their rapes
It’s all but impossible to know exactly how many abortions are performed because of rape exemptions. When they report the procedure, doctors aren’t required to include a reason. And an abortion could fall under a different exemption – such as a fetal anomaly or life of the mother.
Existing annual data suggests that in many states, the numbers of known abortions performed due to rape are in the single digits or, in some cases, zero.
One reason for that is because in many states, rape victims who want an abortion are required to report their assault to law enforcement. Advocates and medical professionals who work with rape victims say in the aftermath of an attack, there are more immediate issues to consider than abortion laws.
“It’s just too much for them to manage at that point,” says Katy Rasmussen, a nurse who works with assault victims with the Johnson County Sexual Assault Response team in Iowa. The patients she sees are frequently in shock or dealing with the stigma around sexual assault. If alcohol or illegal substances are involved, Rasmussen says, patients may feel shame or even blame themselves.
“Often, sexual assault survivors just want it to be over,” says Kelly Miller, former executive director of the Idaho Coalition Against Sexual and Domestic Violence. “And so having to go through the trauma of reporting, the trauma of a forensic interview, most survivors opt out of all of that.”
Other advocates point out that many patients are experiencing domestic violence when they are raped. That’s what happened to Laurie Betram Roberts. She says she became pregnant years ago after she was raped by someone she lived with. Reporting him and risking his arrest, she says, could have meant losing her housing.
“We shared a residence,” she says. “There was no domestic violence shelter that would take me because my family was too big.”
Bertram Roberts, who has seven children, did eventually disentangle herself from this man. She now works with people in similar situations as part of her job with the Mississippi Reproductive Freedom Fund, a nonprofit that helps people get abortion care in that state.
“There’s a perception of good and bad abortions” among people who defend state abortion bans, Bertram Roberts says. “But the truth is the exemptions are all rhetoric and no practical use.”
Last year in Mississippi, there were zero abortions for any reason, according to a recent report from The Society of Family Planning’s WeCount project.
Mississippi Gov. Tate Reeves promised exemptions for rape when the state’s 2022 law went into effect. NPR reached out to Reeves’ office as well as to lawmakers in multiple states who sponsored these bans and to national anti-abortion groups. None of them wanted to speak on the subject of rape exemptions across the country.
One group, Susan B Anthony Pro-Life America, sent NPR a written statement laying blame with doctors and health systems for their confusion and inability to utilize the law. “If there are doctors who are confused about rape exceptions, hospital administrations and health associations should provide clarity,” the statement read.
Some doctors say they feel weaponized and intimidated
Involving law enforcement makes patients and doctors feel like “potential criminals,” says Jessica Tarleton, an obstetrician in South Carolina, where by law, doctors must report abortions performed because of a rape to their local sheriff’s office.
“Somebody comes into the emergency room who’s been shot, we don’t ask them what they did to be in a position to be shot. We take care of the patient,” says Tarleton. She points out that no other kind of medicine demands doctors legally justify care.
“In the past two years,” she says, “I am aware of one one patient that I was associated with that sought a legal abortion under the rape exception.”
Tarleton tries to offer abortion care whenever she legally can. But she says many doctors in this state are scared and feel they don’t have enough support to provide abortions in a place where it feels legally risky. As a result, she says, many distance themselves from the practice altogether.
‘Now I’m the investigator’
Iowa makes it particularly difficult for rape victims to get an abortion, according to doctors and reproductive rights advocates.
This summer, after a long court fight, the state started enforcing a six-week abortion ban, which makes an exception for certain things like rape. But directions from the Iowa Board of Medicine say doctors – before performing an abortion – must determine whether a rape is legitimate or risk legal consequences for noncompliance.
Dr. Emily Boevers says that so far, she hasn’t had to investigate the circumstances around a patient’s rape, but she’s been practicing what she’ll say when that day comes.
Geoff Stellfox for NPR
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Geoff Stellfox for NPR
It’s an unusual level of detail for doctors to collect and document, even among the other 10 states that include exemptions for rape.
“Now I’m the investigator trying to decide if the details of the incident constitute rape as per Iowa Code,” says Dr. Emily Boevers, who works in Waverly, a town of 10,000 in northeastern Iowa. She says these requirements threaten the privacy, trust and intimacy of the patient-doctor relationship. “I’m supposed to maintain a therapeutic, caring relationship with this patient while I query all these details,” Boevers says.
So far, she hasn’t had to investigate the circumstances of assault with a patient, but she’s practicing what she’ll say when that day comes. “Unfortunately, our government mandates that I must ask you some questions,” she plans to say. “If you are able to answer these, I might be able to help you.”
Those who enforce the laws might not always know the laws
In some states, there is little clarity on rape exemptions even among those officials charged with enforcing the laws.
Idaho outlaws abortion with exceptions for rape, incest and when the life of the mother is threatened. To get an abortion, sexual assault victims have to produce a police report for medical providers.
When the state’s ban went into effect in 2022, victim advocates quickly pointed out that law enforcement agencies don’t release police reports until a case is closed – preventing victims from accessing timely care. The following year, the Idaho Legislature amended the bill’s text so that rape victims are entitled to receive, upon request, a copy within 72 hours of the report being made.
But agencies appear to follow these requirements unevenly.
Boise State Public Radio reached out to 56 law enforcement agencies across Idaho about their protocols to assist rape victims since the ban. A handful said they complied with the 72-hour amendment and said their in-house victim advocates were available to help victims throughout their process.
Many others seemed unfamiliar with the amendment. Several public records departments said they would automatically deny requests for copies of a report on an open case, regardless of who made it. One agency realized it hadn’t been complying with the 72-hour law after it went into effect and had unknowingly denied records to rape victims.
Local agencies said they had received no guidance from the state.
Advocates say this murky process compounds a system of reporting that’s already unwelcoming to victims.
“Survivors generally don’t report to these systems that were never created to be centered around survivors in the first place,” says Miller, the former head of the Idaho Coalition Against Sexual and Domestic Violence. “It’s just unrealistic to expect that survivors will access these systems just for the purposes of being able to gain access to an abortion as a result of a pregnancy from a sexual assault.”
State records suggest there were fewer than 10 abortions for any reason last year in Idaho.
Providers of rape-exception abortions often are shielded by big institutions
Only a handful of doctors interviewed for this story reported performing rape exception-abortions with any consistency. Those who did all worked at major academic medical institutions.
Dr. Nisha Verma in Georgia estimates she sees someone who has been raped or experienced incest who meets the exception standard “every couple weeks.”
Verma isn’t an official spokesperson and didn’t want to be identified using her institution’s name. But she says her employer has protocols and task forces to assist doctors in managing their legal risk. That helps mitigate doctors’ fears of losing their medical license, being fined or going to jail.
“At my institution, we have really again worked to create a system that helps us as doctors feel more supported and protected,” Verma says.
But for most people who work with victims, it’s not simply a question of how to get abortion exemptions. Some states, for example, are also constrained by a shortage of providers willing even to deliver babies, let alone perform legally risky procedures.
“The question is,” says Bertram Roberts of the Mississippi Reproductive Freedom Fund, “If you got an exemption in Mississippi, who’s going to perform your abortion?” The state has a significant shortage of obstetricians.
Bertram Roberts says she’s never seen anyone in that state get an exemption – for any reason, let alone rape.
Mr. Trump spends a great deal of his public and private time in the Oval Office. Here, he fields phone calls from allies, hosts hourslong staff meetings and takes questions from reporters while cameras roll.
It’s not unusual for presidents to decorate the space to their own tastes. They often choose art or items meant to evoke meaning and a historical connection to past political eras.
But in his second term, Mr. Trump has placed a connection to his lavish decorating style above all else. His tastes veer toward the gilded, triumphal style of Louis XIV, a theme that shows up in his own properties.
Mr. Trump has regularly added to or swapped out items in the Oval, according to Karoline Leavitt, the White House press secretary. Some of Mr. Trump’s changes go beyond the decorative — he has installed a red button on his desk that lets him instantly order a Diet Coke.
Most objects on the walls are from the White House archive. But a few things, including gold angel statuettes placed above two of the doorways, were brought in from Mar-a-Lago, his estate in Palm Beach, Fla.
Donna Hayashi Smith, the White House curator, and several members of her team spend time pulling portraits and other items from an archive to show Mr. Trump for approval. The president has also traveled to a vault below the White House to see items in person before choosing to display them in the Oval, Ms. Leavitt said.
Mr. Trump was recently shown a portrait of the former first lady Jacqueline Kennedy, which now hangs near the fireplace. Ms. Leavitt said the president added this portrait, the only one of a woman in the office, because he “admires” Mrs. Kennedy.
The Oval Office makeover is among the many changes Mr. Trump has ordered at the White House, including paving the Rose Garden, remodeling the Lincoln bathroom and demolishing the East Wing to build a massive ballroom.
The Golden Stage
Why all the gold?
“He’s a maximalist,” Ms. Leavitt said, citing Mr. Trump’s background in real estate and hospitality. “So he loves showing people who come in, the renovations, his office, his gift shop.”
She added that when traveling overseas, Mr. Trump proudly talks about the White House to world leaders as he invites them to visit him in Washington. “This is the people’s house. It is also the epicenter of the world,” Ms. Leavitt said. “And he genuinely does have a great respect for the White House.”
Almost as soon as he took office, Mr. Trump began adding gold accents to the Oval. By his first bilateral meeting, with Prime Minister Benjamin Netanyahu of Israel in February, there were five gold-framed portraits surrounding the fireplace and nine gold antiques on the mantel. By his October meeting with President Alexander Stubb of Finland, the gold had proliferated.
Mr. Trump also added ornately framed mirrors on two doors leading to other parts of the West Wing. One of them, shown below, covers a peephole where the president’s aides have, in the past, looked through to monitor the progress of meetings.
Now, if the door is closed, they can no longer see what is happening inside the Oval.
The sheer amount of gilded appliqués on the walls of the Oval Office has sparked internet rumors that they are plastic furnishings purchased from Home Depot, painted in gold. Mr. Trump has denied those claims, saying that the appliqués are authentic gold.
A White House official, speaking on the condition of anonymity to describe the process, said that the underlying materials are made of plaster or metal, then covered with real gold leaf. A craftsman from Florida regularly travels to Washington to gild the appliqués by hand, often when the president is away on the weekends, that official said.
Gold is a metaphor the president uses to visually show his success, said Robert Wellington, an art historian at the Australian National University and author of “Versailles Mirrored: The Power of Luxury, Louis XIV to Donald Trump.”
“He’s really setting up a kind of stage — a gilded stage for his presidency,” Mr. Wellington said. “His style is to amass things together to make this look of ‘rich.’ ”
Aside from the gold, Mr. Trump has hung more than 20 portraits in the Oval Office. In addition to Mr. Washington’s above the fireplace, portraits of John Adams, Benjamin Franklin, Andrew Jackson, William Henry Harrison, Abraham Lincoln, James Monroe and Franklin D. Roosevelt are also on the walls.
Mr. Trump has ruminated about the fate of Mr. Harrison, who died shortly after he was inaugurated, to people who have visited the Oval Office. He has said that the portraits of his predecessors are there to remind him of how quickly fate can change.
Most other presidents had just a few portraits or scenery paintings in the Oval.
George W. Bush, June 2005
Barack Obama, October 2014
Even the lighting in the Oval has not gone untouched.
During his first term, Mr. Trump had lights replaced in the Oval to make sure he was better lit during televised appearances.
Now, between the gold and the overhead lights, the room is very bright. The president has recently discussed installing chandeliers, a White House official said.
The Resolute Desk
In this space, Mr. Trump has ceremonies, like awarding medals to the Kennedy Center honorees or the 1980 Olympic hockey team. He has also hosted business leaders, like Apple’s Tim Cook, or other politicians, like New York City’s mayor-elect Zohran Mamdani.
Mr. Trump has recently taken to sitting at the Resolute Desk while people stand behind him at events.
Other presidents have used the Oval Office in a more structured, organized way than Mr. Trump does.
President Joseph R. Biden Jr. used it as a space for briefings with his staff; the list of attendees was tightly controlled by his senior aides. President Barack Obama often arrived at the office in the late morning, worked there until dinner and continued his evening working in the executive residence. President George W. Bush would reach the Oval by early morning, and in the days and months after the Sept. 11, 2001, terror attacks, the office became the backdrop of some of his most significant national addresses.
Mr. Trump treats the Oval Office as something akin to a boardroom or center stage. His most loyal aides are often in the room with him, helping workshop social media posts or fetching documents at his request. Meetings often run long, and sometimes get folded into unrelated events, because the president enjoys looping in more people as the day goes on.
One day this month, Mr. Trump welcomed a conga line of reporters, political allies and at least one cabinet secretary for meetings. He took phone calls and diverted to other subjects, including his plans for the East Wing ballroom. By the end of the day, he was several hours behind his official schedule, according to a person familiar with his schedule.
Smaller details in the Oval Office were still in the works recently. A gold statuette of an eagle flying over the Constitution was added last month near the flags behind the desk.
But Mr. Trump is most likely finished putting up new items, Ms. Leavitt said.
The Oval Office in 360
Tap and drag the image to explore on your own.
Additional photo credits:
George Washington portraits above the fireplace: White House Historical Association (Richard Nixon, Gerald Ford and Ronald Reagan administrations); Everett Collection, via Alamy (Jimmy Carter administration)
Photo of gold coasters and Diet Coke button: Doug Mills/The New York Times
Gifts to Trump: Doug Mills/The New York Times (plaque from Apple); Tom Brenner for The New York Times (FIFA Peace Prize trophy); Eric Lee/The New York Times (Washington Commanders football); Doug Mills/The New York Times (Rolex desk clock)
First responders work at the scene of an explosion and fire at Bristol Health & Rehab Center on Tuesday in Bristol, Pa.
Monica Herndon/The Philadelphia Inquirer/AP
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Monica Herndon/The Philadelphia Inquirer/AP
BRISTOL, Pa. — A thunderous explosion Tuesday at a nursing home just outside Philadelphia killed at least two people, collapsed part of the building, sent fire shooting out and left people trapped inside, authorities said.
Pennsylvania Gov. Josh Shapiro said in a news conference several hours after the explosion that at least two had been killed after emergency responders braved the flames and a heavy odor of gas to evacuate residents and employees.
Fire officials said they were in “rescue mode” five hours later, with responders still digging by hand and using search dogs and sonar to locate potential victims.
The explosion happened at Bristol Health & Rehab Center in Bristol Township, just as a utility crew had been on site looking for a gas leak.
A plume of black smoke rose from the nursing home, as emergency responders, fire trucks and ambulances from across the region rushed there, joined by earthmoving equipment.
Authorities did not identify those who died and did not know the total number of those injured after residents and employees were evacuated to hospitals.
Shapiro asked his fellow Pennsylvanians to take a moment to pray “for this community, for those who are still missing, for those who are injured, and for those families who are about to celebrate Christmas with an empty chair at their table.”
The town’s fire chief, Kevin Dippolito, said at the Tuesday evening news conference that there were five people still unaccounted for, but he cautioned that some may have left the scene with family members.
Dippolito described a chaotic rescue where firefighters found people stuck in stairwells and elevator shafts, and pulled residents out of the fiery building through windows and doors.
Emergency personnel work at the scene of an explosion and fire at Bristol Health & Rehab Center on Tuesday in Bristol, Pa.
Monica Herndon/The Philadelphia Inquirer/AP
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Monica Herndon/The Philadelphia Inquirer/AP
They handed off patients to waiting police officers outside, including one “who literally threw two people over his shoulders,” Dippolito said. “It was nothing short of extraordinary.”
Bucks County emergency management officials said they received the report of an explosion at approximately 2:17 p.m. and said a portion of the building was reported to have collapsed.
Willie Tye, who lives about a block away, said he was sitting at home watching a basketball game on TV when he heard a “loud kaboom.”
“I thought an airplane or something came and fell on my house,” Tye said.
He got up to go look and saw “fire everywhere” and people escaping the building. The explosion looked like it happened in the kitchen area of the nursing home, he said. Tye said some of the people who live or work there didn’t make it out.
“Just got to keep praying for them,” Tye said.
Shapiro said a finding that the gas leak caused the explosion was preliminary.
The local gas utility, PECO, said its crews had responded to reports of a gas odor at the nursing home shortly after 2 p.m.
“While crews were on site, an explosion occurred at the facility. PECO crews shut off natural gas and electric service to the facility to ensure the safety of first responders and local residents,” the utility said in a statement.
Nils Hagen-Frederiksen, press secretary at the Pennsylvania Public Utility Commission, said investigators from the safety division were headed to the scene. Finding that the explosion was caused by a gas leak won’t be confirmed until his agency can examine the scene up close, he said.
Musuline Watson, who said she was a certified nursing assistant the facility, told WPVI-TV/ABC 6 that, over the weekend, she and others there smelled gas, but “there was no heat in the room, so we didn’t take it to be anything.”
The 174-bed nursing home is about 20 miles (32 kilometers) northeast of Philadelphia. Its owner, Saber Healthcare Group, said it was working with local emergency authorities. The facility had been known until recently as Silver Lake Healthcare Center.
The latest state inspection report for the facility was in October and the Pennsylvania Department of Health found that it was not in compliance with several state regulations.
The inspection report said the facility failed to provide an accurate set of floor plans and to properly maintain several stairways, including storing multiple paint buckets and a bed frame under landings.
It also said the facility failed to maintain portable fire extinguishers on one of the three levels and failed to provide the required “smoke barrier partitions,” which are designed to contain smoke on two floors. It also said it didn’t properly store oxygen cylinders on two of three floors.
According to Medicare.gov, the facility underwent a standard fire safety inspection in September 2024, during which no citations were issued. But Medicare’s overall rating of the facility is listed as “much below average,” with poor ratings for health inspections in particular.
Trump was listed as a passenger on eight flights on Epstein’s private jet, according to emailpublished at 11:58 GMT
Anthony Reuben
BBC Verify senior journalist
One of the Epstein documents, external is an email saying that “Donald Trump traveled on Epstein’s private jet many more times than previously has been reported (or that we were aware)”.
The email was sent on 7 January 2020 and is part of an email chain which includes the subject heading ‘RE: Epstein flight records’.
The sender and recipient are redacted but at the bottom of the email is a signature for an assistant US attorney in the Southern District of New York – with the name redacted.
The email states: “He is listed as a passenger on at least eight flights between 1993 and 1996, including at least four flights on which Maxwell was also present. He is listed as having traveled with, among others and at various times, Marla Maples, his daughter Tiffany, and his son Eric”.
“On one flight in 1993, he and Epstein are the only two listed passengers; on another, the only three passengers are Epstein, Trump, and then-20-year-old” – with the person’s name redacted.
It goes on: “On two other flights, two of the passengers, respectively, were women who would be possible witnesses in a Maxwell case”.
In 2022, Ghislaine Maxwell was sentenced to 20 years in prison, external for crimes including conspiracy to entice minors to travel to engage in illegal sex acts and sex trafficking of a minor.
Trump was a friend of Epstein’s for years, but the president has said they fell out in about 2004, years before Epstein was first arrested. Trump has consistently denied any wrongdoing in relation to Epstein and his presence on the flights does not indicate wrongdoing.
We have contacted the White House for a response to this particular file.
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