In the past week, Dr. Jennifer Conti has seen two patients who would be perfectly screwed if House Republicans had their way.

One, Conti told Vogue, was lied to at a crisis pregnancy center posing as an abortion clinic: told that her pregnancy was 12 weeks along when in fact she was 21 weeks in, and conveniently enough, just three weeks shy of California’s 24-week deadline on legal abortion. Probably, CPC staffers sought to run out the clock and obligate the patient to carry the pregnancy to term, Conti—a clinical assistant professor at Stanford University in obstetrics and gynecology and a fellow with Physicians for Reproductive Health—explained.

The second woman, meanwhile, was in the 23rd week of a pregnancy she wanted very much when doctors diagnosed her with a serious heart condition that will require a transplant. Birthing a child would mean risking her life; she landed in Conti’s office just in the nick of time.

Later abortions are rare but not unheard of. “Whether it’s the life of the mother that’s in danger or the life of the fetus, whether [the patients] just didn’t realize they were pregnant until [they were] further along, or whether it’s other laws that are in place that affect their ability to access care sooner, there are so many reasons why women might be in a scenario wherein they need to access medically necessary and safe abortion care after 20 weeks,” Conti said, adding: “It’s really not for the politician to decide when that is.”

And yet politicians keep on trying. The latest effort comes Tuesday, when the House of Representatives votes on a bill that would not only ban abortion nationwide, 20 weeks after fertilization, but also criminalize procedures performed thereafter, with exceptions for instances where the life of the mother is at risk and in cases involving rape or incest. A direct challenge to the terms established by Roe v. Wade—abortion is legal until the fetus is viable outside the womb, a phenomenon medical professionals generally agree occurs around the 24th week of pregnancy—the so-called Pain-Capable Unborn Child Protection Act, or H.R. 36, isn’t likely to pass a Senate vote even if it does advance. (Similar bills failed in both 2013 and 2015.)

But these are different times—a whirlwind nine months that have seen the Global Gag Rule reinstated, Congress attempt to codify the abortion-restrictive Hyde Amendment, and President Trump take aim at Planned Parenthood, among many other calamities—and regardless of its outcome, H.R. 36 should set a field full of red flags waving for any woman concerned about her uterine autonomy. The constant attacks lobbed at reproductive rights speak volumes about the way Republican legislators view women.

Emboldened as antichoice lobbyists are by the rabidly antichoice “A-Team”occupying the White House, it probably shouldn’t surprise anyone to see this particular brand of abortion legislation creep from statehouses to Capitol Hill. In the first quarter of 2017 alone, state legislatures introduced 431 abortion restrictions nationwide. Currently, 17 states bar abortion 20 weeks after fertilization, a legislative maneuver without scientific basis. While medical advancements occasionally mean that a fetus as young as 22 weeks can potentially survive outside the womb—provided doctors intervene immediately and maintain intensive, extended care, and then only with odds so slim that many doctors wouldn’t try—a fetus any younger than that cannot. There’s no gray area.

When Vogue asked what purpose a medically arbitrary 20-week limit on women’s gestation serves, Susan B. Anthony List—an antiabortion group backing H.R. 36—replied that “the Pain-Capable Unborn Child Protection Act protects babies starting at 20 weeks post-fertilization, or 22 weeks gestation,” and insisting that “this legislation is meant specifically to address the humanity of the unborn child in the womb on the scientific truth point that they can feel pain, not whether they are viable.”

Speaking to Rewire, however, SBA president Marjorie Dannenfelser said that while securing the president’s signature was one end, a more immediate aim “is to make sure there is a very high-level public conversation” and to capitalize on the Democratic Party’s demonstrated unwillingness to treat support for abortion rights as a litmus test.

Dannenfelser, it seems, hopes to exploit her opponent’s weakness before the midterm elections, while also lending some legitimacy to misinformation beloved of the antiabortion right: that fetuses can feel pain as early as 20 weeks, when in reality, the neural pathways that allow them to do so don’t develop until around the 28th week of gestation. That’s one aspect of H.R. 36 that worries Conti.

“The really divisive and sneaky thing about this is that, on the surface, it looks like something that’s designed to protect women, and that’s not an accident,” she said. “You’ll see a lot of these bills framed in a way where, if you haven’t done research into this topic, or you haven’t sat down with a family going through this scenario, you might think, Well, that’s actually a good thing—is there a gestational age at which we need to stop [performing abortions]?”

Seeing 20 weeks touted, again and again, as that gestational age could change people’s opinions, with brutal consequences for women.

According to the Guttmacher Institute, the vast majority of abortions occur in the first trimester (weeks one to 13): Just 9 percent are performed after 14 weeks, and 1 percent at or after 21 weeks. The women who make up that 10 percent typically face some kind of hardship. Some, like Conti’s patient with a heart condition, are people for whom pregnancy poses a grave health threat; others are the same groups continually disenfranchised by our nation’s health-care system.

“It’s going to be young people, it’s going to be women of color, low-income women, and immigrant women,” Dr. Jamila Perritt—vice chair for Advocates for Youth’s Board of Directors, a fellowship-trained obstetrician and gynecologist, and a fellow with Physicians for Reproductive Health—told Vogue, ticking off H.R. 36’s prospective casualties. As Perritt noted, these women don’t necessarily get to have abortions precisely when they want them, thanks to an accumulation of hurdles (mostly) white, male legislators place in their way.

Consider the timeline: A woman might not realize she’s pregnant until she’s missed a period or two. Best-case scenario, she’ll make the discovery while she’s still in her first trimester and manage to book an appointment before the cost of the procedure—typically around $500— slides up to second-trimester rates, which can run into the thousands. And best-case scenario, she’ll have saved up enough money to be able to afford that emergency expense—although in a country where 69 percent of adults have less than $1,000 in savings, that’s an unlikely proposition.

The scramble to raise funds for an abortion often forces low-income women into second-trimester procedures, their difficulty compounded by a slew of hidden costs: dwindling clinic numbers mean traveling longer distances to get abortions, and enduring longer wait times for appointments. They mean securing and paying for child care (in 2014, 59 percent of abortion patients were already parents); locking in transportation or finding someone to drive, quite possibly across state lines; forgoing pay to take time off work not just for the procedure, but also for the counseling many states deem mandatory a day, or two days, or three days in advance. This logistical nightmare takes time to resolve, potentially more than 20 weeks. Legislators know this—they designed the bureaucratic puzzle that way. And according to Perritt, that willful ignorance betrays a more sinister motivation.

“Politicians who claim to truly care about women’s health and their well-being really should focus on policies that advance healthy pregnancies,” Perritt said. They should focus on policies that expand access to things like contraception, especially for low-income communities. But that’s the opposite of what congressional Republicans have done under Trump.

The most obvious piece of evidence here is the GOP’s Affordable Care Act repeal, every iteration of which—from Paul Ryan’s failed American Health Care Act to Mitch McConnell’s thwarted carbon copy to the Graham-Cassidy iteration that Planned Parenthood blasted as going “even further to devastate women and families” than its predecessors did—has portended particular doom for uterus-havers and children alike. Consistent themes were gutting Medicaid; making abortion harder to finance; shuttering Planned Parenthood and blocking access to preventative health services for its low-income patients; and imposing roundabout financial penalties on women who’d given birth or had C-sections, all while eliminating the guarantee of insurance coverage for maternal and newborn care.

H.R. 36, Republicans’ most recent effort to torpedo women’s health, follows closely on the heels of the Graham-Cassidy bill’s collapse last week. The timing strikes both Conti and Perritt as suspicious, suggesting that when legislators couldn’t accomplish a task one way, they found another. “Was the impact of all of these previous attempts to undo the ACA really aimed at women’s health?” Conti wondered. The sequence of events heavily suggests a hierarchy of priority.

“I think you’d have to be blind not to see that it’s part of a larger agenda,” Perritt agreed. “This is not about health care, it’s not about science; it really is about removing access overall.” We already know what happens when women can’t get the abortions they want; it’s not usually advancement, and indeed that seems to be the point.

https://www.vogue.com/article/house-votes-on-20-week-abortion-ban