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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.
When Stuart Sepulvida arrives at St. Francis de Sales Roman Catholic Parish in Tucson, Ariz., for Mass, which he attends most mornings, he passes a display honoring local soldiers and encouraging parishioners to pray for their safety. Hundreds of small cards record their names: Robles, Arenas, Grajeda. A portrait of Pope Leo XIV hangs across the lobby.
Mr. Sepulvida, 81, is a Vietnam veteran whose patriotism and Catholicism are deeply intertwined. He voted for President Trump three times but has never felt more betrayed by an American president than when Mr. Trump denounced Pope Leo as “weak on crime” and “terrible for foreign policy.”
“It was very disturbing to me to hear both of them clashing like they did,” Mr. Sepulvida said, standing outside the church one morning this week. Now, he is reconsidering whether he will vote Republican this year.
The Republican Party is struggling to hold onto the support from Hispanic voters who helped propel Mr. Trump back into the White House in 2024. Yet as many party leaders have acknowledged the urgent need to stop the backsliding among Latinos, the president has enraged many of even his strongest supporters by clashing with the pope.
On Easter Sunday, Pope Leo, the first U.S.-born pontiff, spoke of the need to “abandon every desire for conflict, domination and power, and implore the Lord to grant his peace to a world ravaged by wars.” Within days, Mr. Trump, who has led the United States into a war with Iran, said the pope was “catering to the radical left” and posted an AI-generated image portraying himself as a Jesus figure. Mr. Trump later deleted the image, saying he thought it depicted him as a doctor.
“It just isn’t what a president should do,” Mr. Sepulvida said. “The pope speaks for his people. He is beyond politics.”
Mr. Trump won 55 percent of Catholic voters in the 2024 election, compared to 43 percent who voted for former Vice President Kamala Harris, according to Pew Research Center. The most sizable gains came from Hispanic Catholics. While Joseph R. Biden Jr. won their votes by a 35-point margin in 2020, the Democratic advantage shrunk to 17 points in 2024. Now, just 18 percent of Hispanic Catholics said they support most or all of President Trump’s agenda, according to a poll from Pew released earlier this year.
If the president’s quarrel with the pope sours more Latinos on the Republican Party, it could affect midterm races across the country, including in South Florida and South Texas, where Republicans have notched important victories in predominantly Hispanic districts in recent years.
In Arizona’s Sixth Congressional District, which stretches from north of Tucson to the Mexican border, voters were still grappling with the fallout this week.
The district is roughly evenly divided among Republicans, Democrats and independent voters. Nearly a third of the district is Hispanic, and there is a significant population of members of the Church of Jesus Christ of Latter-day Saints, as well as a large Catholic community with deep history in the region. It also has one of largest numbers of military veterans of all congressional districts in the country.
“The president is looking for a lot of attention from everything,” said Maria Ramos, 60, who regularly attends weekday Mass at St. Francis. A registered independent, she usually votes for Democrats but often declines to cast a ballot if she views a candidate as too liberal. “He believes he can put God in his place. He’s meddling in countries that he’s not in control of — he wants to control the world.”
“It is not just a very serious lack of respect — it is a mortal sin,” she said, shaking her head. One word comes to her mind again and again, she said: disgust.
Like so many others in southern Arizona, Ms. Ramos has several relatives who serve in the military — a path they saw to both serve the country and as an entry into the stable middle class. Many of them, she said, voted for Mr. Trump for president.
The Tucson district is now widely seen as one of the most competitive in the country. Republican Juan Ciscomani narrowly won the district in 2022, in part by emphasizing his biography as a Mexican immigrant and a devoted father of six children. He is also an evangelical Christian, a group that has driven much of the growth among Hispanic Republican voters in recent years.
Mr. Ciscomani declined a request for an interview, but when a local radio host asked Mr. Ciscomani what he thought of Mr. Trump’s comments “as a man of faith,” the congressman declined to criticize the president but said, “You can trust that you won’t see any meme like that coming out of my account.”
JoAnna Mendoza, the Democrat challenging Mr. Ciscomani this fall, has made her 20-year career in the U.S. Navy and Marines a key aspect of her story on the campaign trail. While she rarely speaks about her religious background and no longer considers herself a practicing Catholic, she said she briefly considered becoming a nun as a teenager. She criticized Mr. Ciscomani for not condemning the president’s remarks.
“You can’t make faith a central part of your campaign and then allow this to stand,” she said in an interview.
Across Tucson, Latino Catholics, regardless of their past voting preferences, were similarly quick to condemn the president’s remarks.
When Cecilia Taisipic, 71, heard about it, she said, she winced with shame about her vote for him in 2024.
“I thought he would make the country better, but apparently it’s the opposite,” she said as she left Mass at St. Francis earlier this week. She is so fed up with politics, she said, that she is unlikely to vote at all this year. “When it comes to my faith, I don’t like anybody to challenge it. Now I don’t want to hear anything on the news. I just want to pray.”
Matilde Robinson Bours, 63, teaches a weekly Spanish Bible study class at St. Thomas the Apostle Parish, and like nearly all of the women in her class, she immigrated from Mexico decades ago. She has voted for Republicans in nearly every election since she became a citizen. Though she has never liked President Trump, she said, his comments about the pope enraged her more than anything else he has said or done in the past.
“This surpassed everything, every social and political norm — this is personal to all Catholics,” she said. “The arrogance and ego is disgusting. To think that he is God? The pope has every right and responsibility to talk about peace.”
Still, Ms. Robinson Bours said, nothing will stop her from supporting Republicans again this year. She has been delighted that her adult children have stopped supporting Democrats in recent elections.
“Almost everyone I know thinks the way I do,” she said.
Patricia Martinez, 86, who has attended the same Bible study as Ms. Robinson Bours for years, shook her head in disagreement. She said she cannot imagine voting for a Republican who supports Mr. Trump.
“This is different — this shows he is out of his mind,” said Ms. Martinez. “We have to have basic respect and teach that to people in this country.”
Patrick Robles, a 24-year-old native of Tucson, spent years alienated from the Roman Catholic Church, but returned to his faith more recently. “The craziness of the world sort of caused me to seek some sort of answers,” he said. Now, he attends Mass at the St. Augustine Cathedral in downtown Tucson, a few blocks from the office where he works as an aide to Representative Adelita Grijalva, a Democrat.
Mr. Robles said he saw Mr. Trump’s battle with the pope as both a personal affront and a political opportunity.
“The president is basically trying to draw a line between Catholics and what we perceive to be patriotism,” he said. “I believe we can be both.”
Last week, he texted one of his uncles who has supported Mr. Trump in every election asking him what he thought.
“I’m afraid we need divine intervention,” the uncle replied.
Speaker of the House Mike Johnson, R-La., takes questions at a news conference at the Capitol on Tuesday.
J. Scott Applewhite/AP
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J. Scott Applewhite/AP
Speaker Mike Johnson, R.-La., is forging ahead with his latest proposal to renew a key American spy power. His bill, revealed Thursday, is largely unchanged from a previous plan which failed in a series of overnight votes earlier this month.
The program at center of the debate, Section 702 of the Foreign Intelligence Surveillance Act (FISA), is set to expire on April 30.
FISA 702 allows U.S. intelligence agencies to intercept the electronic communications of foreign nationals located outside of the United States. Some of the nearly 350,000 foreign targets whose communications are collected under the provision are in touch with Americans, whose calls, texts and emails could end up in the trove of information available to the federal government for review.
For almost two decades, privacy-minded lawmakers from both parties have sought to require specific court approval before federal law enforcement can conduct a targeted review of an American’s information gathered through the program. The lack of any such warrant requirement helped sink an effort last week to extend the program for 18 months, as well as a separate vote on a five-year renewal.
Trump officials, like those in past administrations, have argued that such a warrant requirement would overburden law enforcement and endanger national security. Johnson’s latest proposal would reauthorize the program for three years, but does not include a warrant requirement. Instead, the bill calls for the FBI to submit monthly explanations for reviews of Americans’ information to an oversight official as well as criminal penalties for willful abuse, among other tweaks.
“I am willing to risk the giving up of my Rights and Privileges as a Citizen for our Great Military and Country,” the president wrote on Truth Social last week, advocating for the program to be extended without changes. “I have spoken with many in our Military who say FISA is necessary in order to protect our Troops overseas, as well as our people here at home, from the threat of Foreign Terror Attacks. It has already prevented MANY such Attacks, and it is very important that it remain in full force and effect.”
Glenn Gerstell, who served as general counsel at the National Security Agency during the Obama and first Trump administration, says Johnson’s reforms look like an attempt to find a middle ground.
“There’s not a lot of really substantive changes to the statute, but some gestures are made to people who are worried about privacy and civil liberties,” Gerstell said. “It seems like a pretty reasonable compromise that is going to be satisfactory to the national security agencies and yet at the same time represents some gesture to the privacy advocates.”
“This is not a reform bill and it’s not a compromise,” Elizabeth Goitein, a privacy advocate and senior director of the Liberty and National Security Program at the Brennan Center for Justice at New York University, wrote on X. “It’s a straight reauthorization with eight pages of words that serve no serious purpose other than to try to convince members that it’s NOT a straight reauthorization.”
A bipartisan reform deal is still out of reach
Connecticut Rep. Jim Himes, the top Democrat on the House Intelligence committee, told NPR on Wednesday, before the release of Johnson’s new proposal, that lawmakers were working on a bipartisan solution. He said House Minority Leader Hakeem Jeffries, D-N.Y., was in touch with Johnson on the issue.
“There’s a lot of work being done here,” Himes said. “We’re sort of working out a process that will be inclusive rather than exclusive.” Himes said he was negotiating with Rep. Jamie Raskin, a Maryland Democrat and constitutional law scholar, on a reform proposal they hoped could preserve and reform the program — reauthorizing it with bipartisan support.
But Johnson’s new bill appears to fall short of the inclusive approach Himes hoped for.
NPR obtained a memo written by Raskin to his colleagues urging them to oppose the bill, which he said “continues the disastrous policy of trusting the FBI to self-police and self-report its abuses of Section 702 and backdoor searches of Americans’ data.”
“FBI agents can still collect, search, and review Americans’ communications without any review from a judge,” Raskin wrote.
FBI agents must receive annual training on FISA and are generally barred from searching for information about people in the U.S. if the goal of the search is to investigate general criminal activity, rather than find foreign intelligence information, and those searches need approval from a supervisor or an attorney.
Republican hardliners — who sunk Johnson’s last reauthorization attempt — also don’t all appear to be on board for Johnson’s latest revision. Rep. Scott Perry of Pennsylvania, a past chair of the Freedom Caucus, said “we’re not there yet” in a video he shared to X on Thursday.
“I didn’t take an oath to defend FISA, I didn’t take an oath to defend the intelligence community,” Perry said. “We can’t have them spying on American citizens and, when they do, there has to be accountability and I haven’t seen any that I’m satisfied with yet.”
The House Rules committee meets Monday morning, the first step toward advancing the renewal bill toward a vote.
President Trump announced a three-week extension of a cease-fire between Israel and Lebanon that had been set to expire in a few days, after hosting a meeting between Israeli and Lebanese diplomats at the White House on Thursday.
Hezbollah, the Iranian-backed militant group that has been attacking Israel from southern Lebanon, did not have representatives at the meeting and did not immediately comment on the announcement. The prime minister of Israel and the president of Lebanon also did not comment.
A successful peace agreement would hinge upon Hezbollah halting attacks, which Lebanon’s government has little power to enforce because it does not control the militia. Lebanon’s military has mostly stayed out of the fighting and is not at war with Israel.
The cease-fire, which was scheduled to end on April 26, would last until May 17 if it takes effect as Mr. Trump described it. Before the cease-fire was brokered last week, nearly 2,300 people were killed in Lebanon and 13 in Israel. Since then, the number of Israeli airstrikes and Hezbollah attacks have been dramatically reduced, though the two sides have continued exchanging fire.
The Lebanese Ambassador to the United States, Nada Hamadeh, credited Mr. Trump for extending the cease-fire, saying that “with your help and support, we can make Lebanon great again.” Mr. Trump replied, “I like that phrase, it’s a good phrase.”
Asked about the potential of a lasting peace agreement between Israel and Lebanon, Mr. Trump said that “I think there’s a great chance. They are friends about the same things and they are enemies on the same things.”
But Lebanon and Israel have periodically been at war since Israel’s founding in 1948. Israel has invaded Lebanon for the fifth time since 1978, incursions that have destabilized the country and the delicate balance of power between Muslim, Christian and Druze communities.
In the hours before the president’s announcement on social media, Israel and Hezbollah were trading attacks in southern Lebanon, testing the existing cease-fire.
Mr. Trump said the meeting at the White House had been attended by high-ranking U.S. officials, including Vice President JD Vance, Secretary of State Marco Rubio and the U.S. ambassadors to Israel and Lebanon.
Earlier on Thursday, an Israeli strike near the southern Lebanese city of Nabatieh killed three people, according to Lebanon’s health ministry. Hezbollah claimed three separate attacks on Israeli troops who are occupying southern Lebanon, though none were wounded or killed.
Hezbollah set off the latest round of fighting last month by attacking Israel soon after the start of the U.S.-Israeli bombing campaign in Iran. Israel responded to Hezbollah’s attacks by launching airstrikes across Lebanon and widening a ground invasion of the country’s south.
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