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. Termination may also be chosen because a fetus has lethal congenital abnormalities.

With Roe 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 already 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 who faces such restrictions because he practices in Ohio, where abortion is banned at 22 weeks or later.

“Pregnancy in the lowest-risk circumstances is higher risk than abortion care in the first trimester,” says Dr. Hackney, who also serves as an associate professor of reproductive science at the Case Western Reserve University School of Medicine in Cleveland. That’s especially true in the United States, which has the highest rate of maternal mortality in the developed world.

“So every patient, regardless of risk, who does not want to be pregnant is having their lives be endangered by the overturning of Roe.”

Abortion Can Be a Lifesaving Option in High-Risk Pregnancies

Maternal-fetal medicine (MFM) is a subset of obstetrics and gynecology that treats pregnant people and their growing fetuses. MFM practitioners are further specialized to support patients with high-risk pregnancies. Most people who go to see MFM providers want to be parents and want continue their pregnancy.

Carrying a fetus to term is an intense process for the body even in ideal circumstances. The energy and nutrients required for pregnancy are especially taxing on the heart, lungs, and kidneys — to say nothing of the challenges posed by labor itself. Vaginal tears and excessive bleeding, as well as many other birth-related complications, can extend hospital time after delivery.

But when pregnant people require lifesaving abortions, they often agonize over the decision, says Meghana Limaye, MD, who works as an MFM 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.”

According to the Guttmacher Institute, people who’ve already had a child — and know the commitment it takes to be parent — make up the majority of people who choose abortion. Medically necessary abortions obtained by people wanting to have a baby can be among the most difficult choices to make.

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

1. Pulmonary Hypertension

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.

2. Ectopic Pregnancy

In normal, viable 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. It can cause the fallopian tubes to rupture, which results in life-threatening internal bleeding.

Fetuses cannot grow and develop fully outside the uterus, so all ectopic pregnancies are nonviable. The treatment for ectopic pregnancy is abortion, which saves the life of the pregnant person. In these cases, though, the medication methotrexate or laparoscopy are used to terminate the pregnancy, rather than the typical medications or surgery.

3. Severe Preeclampsia

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, Hackney explains.

4. Severe Kidney Disease

Kidney disease bears a sliding scale of risks for pregnant people, according to the National Kidney Foundation. To complicate matters, diabetes and high blood pressure, two of the most common conditions in the United States, are known causes of kidney disease, according to the Mayo Clinic.

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

5. Cancer

As a whole, cancer treatment in pregnant people has improved dramatically in the past decades, but sometimes the recommended treatment is not safe during pregnancy. In such a scenario, a pregnant person may choose abortion so they can pursue the treatment for their cancer.

Unfortunately, some states with restrictive abortion laws do not allow exceptions for cancer treatment, which could lead to problems later on. “To some extent, you don't know the consequences of denying patients abortion care when they have health problems, even a year later,” says Hackney.

If a person with cancer can’t get an abortion, the adverse health consequences may not be as directly notable, he explains. Down the line, someone’s cancer prognosis could worsen or reoccur because they didn’t get a particular treatment, such as some radiation treatments, even if the pregnant person still can get chemotherapy and surgery.

6. Lethal Fetal Anomalies

Tragically, some fetuses develop life-threatening abnormalities. A common example is when babies are born without fully developed brains or skulls, a condition called anencephaly. This defect shows up on prenatal screenings. Babies born with anencephaly die shortly after birth.

“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 be able to provide them with abortion care,” says Hackney.

Abortion in this scenario can be lifesaving simply because abortion is much safer than delivery. In the United States, research shows fewer than 1 person in 100,000 dies from an abortion, while according to the CDC nearly 18 in 100,000 people die from pregnancy-related complications — a nearly 20-fold increase in the risk of death.

The risks are even higher for minority women: Per 100,000 live births, over 41 Black women and more than 26 American Indian or Alaska Native women die of pregnancy-related complications each year.

All Pregnant Patients Deserve the Option to Choose Abortion

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.

Ohio’s new restrictive abortion laws have few exceptions for medical risk, forcing medical providers to weigh their best good-faith position under the law while caring for pregnant individuals.