On Tuesday, the US state of Georgia governor Brian Kemp signed one of the most extreme anti-abortion bills into a law. The so-named "heartbeat bill," HB 481, bans abortions as soon as there's a "detectable human heartbeat," which can be as early as six weeks into pregnancy. Georgia is the fourth state to enact a bill like this, along with Ohio, Kentucky, and Mississippi. The Ohio, Kentucky, and Mississippi laws are being challenged in court, and a suit is expected to be filed in Georgia shortly as well.
This spate of "heartbeat" bills is extreme, but it's only the tip of the iceberg right now. The state of Alabama is currently debating a bill to ban abortion outright and make it punishable by up to 99 years in prison. And since the beginning of 2019, more than 300 pieces of legislation have been introduced aimed at severely restricting or altogether banning access to abortion care in the United States, according to the American College of Obstetrics and Gynaecology (ACOG).
As many pro-choice advocates have pointed out, the "heartbeat" bills are also, in effect, a total abortion ban because many women do not realise that they're pregnant at such an early stage of gestation. This is why, in addition to reproductive rights groups, the medical establishment is also calling for repeal of the law.
ACOG is "gravely concerned" for the health and wellbeing of families and women in Georgia, David Byck, MD, chair of the Georgia section of ACOG says in a statement to Refinery29. "Health care policy must be based on scientific evidence and medical necessity," he says. "This legislation reflects neither of those standards. It is dangerous and medically unnecessary."
"This is just people playing politics with medicine, because the end goal is really just to ban abortion outright," adds Sarah Horvath, MD, FACOG, Ob/Gyn and family planning expert in Philadelphia. "Once again, we’re seeing people at the state level who are preventing women from getting necessary medical care in whatever arbitrary way they can."
In this case, the arbitrary measurement is the "foetal heartbeat," which has been a target for anti-choice activists for years. Anti-choice activists have used this concept in billboards and propaganda for decades, so this is straight out of their anti-science and anti-women's health playbook. "There are no medical reasons for any of these arbitrary dates to be chosen," Dr. Horvath says. Furthermore, "this confusion around state laws is really detrimental to women," she says. The reality is there are genuine health consequences to a de facto abortion ban like this one. Women in Georgia who seek illegal abortions, or who try to self-terminate, as a result of this ban could put their health in danger by forgoing medical care. Women who experience miscarriages may be fearful of seeking help, if they fear potential criminal charges that carry up to 30 years in prison.
Ahead, Dr. Horvath helps us break down the scientific truth about the foetal heartbeat, gestational development, and what you need to know to protect your health.
Why "Heartbeat Bill" Is A Misnomer
Though the law allows narrow exceptions for life endangerment of the mother and for certain cases of rape and incest, the language of the bill states that, no abortion is authorised or shall be performed if "an unborn child has been determined to have a detectable heartbeat." This is misleading for several reasons. First, it suggests that an early-developing embryo has the same heartbeat as a baby on its birthday. But that's not even close to the truth, Horvath says. At that stage of development, it's not really a "heartbeat" at all.
Really, a foetal heartbeat is an electrical flicker that shows that the tissue that will eventually become the heart is beating, Dr. Horvath says. Some say "foetal heartbeat" is a misnomer, and "foetal pole cardiac activity" would be more accurate. The "foetal pole" is the first visible sign of a developing embryo, and it's essentially the thickening of the membrane of a yolk sac. So, foetal pole cardiac activity means that the yolk sac that becomes an embryo is experiencing an electrical current that we can interpret as a heartbeat on an ultrasound.
Foetal development is an ongoing process that happens over many months, and foetal circulation and newborn circulation are two very different things, Dr. Horvath adds. "It's really when a viable newborn baby takes its first breath that we’re talking about the completion of that process," she says. That said, "viable" is another word that people intentionally use to confuse the issue: "Viability really refers to the ability of that pregnancy to survive outside of the environment of the uterus, and be its own living, breathing entity," she says. In a typical healthy pregnancy, this is generally around 24 weeks, she says. However, because there are other factors that can come into play, such as the specific woman's health risks, many pregnancies may never become viable. Every pregnancy is personal.
Why A "Heartbeat" Ban Is A Total Abortion Ban
Right now, the earliest that foetal pole cardiac activity is detectable by ultrasound technology is around six weeks. But this could change in the future. When someone says six weeks of gestation is the point when a foetal heartbeat is first detectable, what that really means is it's the "particular point in pregnancy when the ultrasound technology happens to be good enough to detect what is a flicker on the screen," Dr. Horvath says. There's nothing particularly significant about the six-week point, except that it's a point where many women won't know they're even pregnant which makes it very likely that termination won't be an option for a large swath of women, Dr. Horvath says.
On top of that, six-weeks pregnant is not what you might think. The way that doctors date pregnancies is based on a time before ultrasounds were available, and they had to rely on menstrual cycles, she explains. "When you say that a woman is six weeks pregnant, what you're saying is, it’s been six weeks since the last time she had her period," she says. "She has probably actually only had an implanted pregnancy for two weeks less than whatever time we’re talking about."
This reveals the true aims of these laws: to prevent women from accessing care, Dr. Horvath says. "To assume that she would be able to overcome all the other sort of barriers that have been put in her way in order to obtain this care that she knows she needs is frankly offensive."
What To Know If You Need An Abortion In Georgia
Georgia's new law is in direct conflict of Roe v. Wade, the U.S. Supreme Court decision that made abortion legal. The ACLU and Planned Parenthood already have plans to challenge the law in court — meaning, this is not effective immediately and likely will be tied up in court for some time. What you need to know now is that, despite anti-choice activists' best efforts, reproductive choice is a legal right. Services like Refinery29's state-by-state guide to abortion restrictions and I Need Dana can help connect you to providers and other resources in your area.
The choice to terminate a pregnancy can be a complicated one involving many deeply personal, and private considerations, so you should also know that judgement-free non-directive counselling is available if you want it. "[Women] need to be able to come in, and speak with their physician, and have those caring, trusting relationships where they can discuss what their options truly are," Dr. Horvath says.
Update: This story has been updated to clarify that the law does include narrow exceptions for life endangerment, rape and incest.