6 Medical Reasons for Abortion

While some people seek abortions because they don’t want to be a parent, others choose to terminate because continuing a pregnancy could put their life in danger.

With Roe v. Wade overturned, and abortion access now determined by a patchwork of state laws, even people who want to continue their pregnancies have less control over their health.

In states with restrictive abortion laws, medical providers and their patients are feeling the unease that comes with fewer options. That’s especially true in cases of high-risk pregnancy, according to David Hackney, MD, a maternal-fetal medical doctor and associate professor of reproductive science at the Case Western Reserve University School of Medicine in Cleveland.

Having a Medical Reason for Abortion Doesn’t Make the Decision Any Easier

When pregnant people require lifesaving abortions, they often agonize over the decision, says Meghana Limaye, MD, a maternal-fetal medicine specialist and clinical assistant professor in the department of obstetrics and gynecology at NYU Langone Health in New York City.

“It's not a decision that anybody takes lightly, especially in the context that I see it, in terms of high-risk pregnancies,” says Dr. Limaye. “Having that option is such an important part of being in control of your health and your life. I just wish people would know that and think about it from the perspective of someone who maybe never thought they would get an abortion.”

Here are six common reasons why abortion can be medically necessary — and lifesaving.

Pulmonary hypertension is when the pressure of the blood vessels connecting the heart and lungs is too high, which puts a huge strain on the body. In order to pump blood to the lungs, the heart has to work too hard. When you’re pregnant, your heart is already working harder to pump blood, because it has the additional task of nourishing a growing fetus.

“You can go into really bad heart failure and there's a 50 percent rate of mortality — of dying in the pregnancy if you get pregnant with that condition,” says Limaye.

Abortion in this case is an option that can save the pregnant person’s life.

In normal pregnancies, a fertilized egg implants in the uterus and grows into a fetus. But sometimes the fertilized egg implants elsewhere, such as inside the fallopian tubes. These pregnancies are called ectopic pregnancies, and are highly dangerous. They can cause the fallopian tubes to rupture, which results in life-threatening internal bleeding.

Limaye says that about halfway through gestation, a pregnant person can develop a life-threatening condition called severe preeclampsia — a dangerous increase in blood pressure that can damage other organs. Induced delivery is often the recommended treatment when severe preeclampsia is diagnosed, because the risks of continued gestation are so high.

“She can have a seizure, she could have a stroke, she could have damage to her other organs like her kidney or liver and get really sick,” Limaye says of the pregnant parent. “Termination can be the safest option in that setting.”

Inducing delivery before 24 weeks would be considered an abortion, since a fetus is highly unlikely to survive outside the uterus before that point. It is possible, however, to continue a pregnancy with severe preeclampsia up to 34 weeks with very close monitoring.

Preeclampsia goes away after pregnancy ends, Dr. Hackney explains.

Pregnancy already increases the workload for the kidneys, so people with kidney disease have a higher chance of both pregnancy complications and kidney failure, Hackney says.

While certainly not all people with kidney disease who get pregnant will experience life-threatening complications, some people with severe kidney disease may be advised to end a pregnancy if the risk to the mother and fetus is too high, Hackney says.

As a whole, cancer treatment in pregnant people has improved dramatically in the past decades, but sometimes the recommended approach (such as radiation therapy) is not safe during pregnancy. In such a scenario, a pregnant person may feel compelled to choose abortion.

Unfortunately, some states with restrictive abortion laws do not allow exceptions for cancer treatment.

If a person with cancer can’t get an abortion, the health consequences may not be immediately obvious, says Hackney. Down the line, though, their prognosis could worsen.

“There are definitely patients who are going to have lethal fetal anomalies, who are definitely going to have to continue the pregnancy against their will because we’re not going to be able to provide them with abortion care,” says Hackney.

The risks are even higher for minority women: Per 100,000 live births, over 69 Black women and more than 118 American Indian or Alaska Native women die of pregnancy-related complications each year.

Maternal-fetal medicine specialists like Limaye and Hackney know the true value of abortion as medical care, especially as providers who guide people through complicated, high risk, and difficult pregnancies.

“It's such an important choice that I give them where they have the option to not continue a pregnancy where the baby is at high risk or they're at high risk,” says Limaye.

Limaye practices in New York, a safe haven for abortion access. In contrast, Hackney’s work environment in Ohio has changed with the legal landscape since the Dobbs decision.

“It’s the patients themselves who should balance the two scales with the medical risk on one side and their desire to be pregnant on the other,” Hackney says.

• Pregnancy can be dangerous in some instances. Abortion could save the pregnant person's life.
• Medical reasons for abortion include pulmonary hypertension, ectopic pregnancy, severe preeclampsia, severe kidney disease, and cancer.
• Doctors may be reluctant to perform lifesaving abortions in states with abortion bans out of fear they will be prosecuted or lose their medical license.