In a Republican presidential field full of opponents to abortion rights, Mike Pence stands out in his embrace of the cause.
The former vice president, who is seeking the White House in 2024, is the only candidate who supports a federal ban on abortion at six weeks, before many women know they’re pregnant. He has advocated pulling from the market one of two widely used abortion pills, a medication with a better safety record than penicillin and Viagra. And he's implored his Republican rivals to back a 15-week federal ban as a minimum national standard, which most have not done.
In a recent interview, Pence went even further, saying abortion should be banned when a pregnancy isn't viable. Such a standard would force women to carry pregnancies to term even when doctors have determined there is no chance a baby will survive outside the womb.
“I’m pro-life. I don’t apologize for it,” Pence said. “I just have heard so many stories over the years of courageous women and families who were told that their unborn child would not go to term or would not survive. And then they had a healthy pregnancy and a healthy delivery."
Doctors disputed Pence’s characterization, saying there are conditions that are always incompatible with life and others where the chance of survival is so slim that most patients, when previously given the choice, concluded that continuing the pregnancy wasn’t worth the risks.
Pence, however, is undeterred.
“I want to always err on the side of life,” he said. “I would hold that view in these matters because ... I honestly believe that we got this extraordinary opportunity in the country today to restore the sanctity of life to the center of American law.”
Those comments place Pence firmly to the right of the 2024 presidential field and alone among GOP candidates, who largely declined to take a stance on the issue. And they drew alarms from obstetricians and doctors who say nonviable pregnancies are far more common than people realize. Those range from ectopic pregnancies, when an embryo implants somewhere other than the uterus, to fatal fetal abnormalities and severe pregnancy complications.
Banning abortions in these cases, doctors say, leads to outcomes that are cruel and put women’s lives and mental health at risk.
“One of the things that you cannot understate is the difficulty for a woman to carry a nonviable pregnancy,” said Alan Peaceman, professor emeritus of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine. “It is psychological torture to go out in the world, for people to see your pregnancy — and people will come up to you and want to talk about your pregnancy. And that puts the woman in a terrible position that nobody should be in unless they chose to be in that position.”
Once an issue largely hidden from public view, nonviable pregnancies have faced greater scrutiny since the Supreme Court ended the constitutional right to an abortion last year, ushering in a wave of bans and restrictions in Republican-led states. Those moves have implications not only for unwanted pregnancies but also for cases in which women receive heartbreaking diagnoses, often when they’re months along into pregnancies that were deeply desired.
In states like Texas, Florida and Louisiana, women have described the anguish of being denied abortions even when they know their babies will be stillborn or die shortly after birth. Some have had to wait until they developed life-threatening infections for intervention. Others have spent thousands of dollars to travel to states where the procedure is still allowed.
Sarah Prager, a professor of obstetrics and gynecology at the University of Washington Medical Center, said she and her colleagues have seen a steady stream of patients coming from states where abortions are now banned. About 11% of those patients, she said, have received a serious diagnosis, including cases in which there is no chance of the fetus surviving.
“They are often absolutely shocked to learn that the abortion laws also prohibit them from being able to get care to be safe,” she said.
Spokespeople for leading Republican presidential candidates, including former President Donald Trump, largely declined to say whether they back Pence’s position. Trump, the early front-runner, has repeatedly said he backs exceptions in cases of rape, incest and the life of the mother and blamed hard-line abortion stances for costing the party in last year’s midterm elections.
Florida Gov. Ron DeSantis, who is polling a distant second, signed a six-week ban in Florida that includes an exception for fatal fetal abnormalities, along with rape, incest and to save the mother’s life. He has declined to say whether he supports a federal ban.
A spokesperson for former U.N. Ambassador Nikki Haley, the sole woman in the GOP field, said she “will sign pro-life legislation that includes exceptions for rape, incest, and for the life of the mother,” suggesting she, too, may be opposed to an exception for nonviable pregnancies — but declined to clarify.
Pence’s push to end abortion puts him at odds with the majority of Americans who broadly oppose the Supreme Court’s Roe v. Wade reversal.
But Pence, an evangelical Christian, argues that restricting abortion is “more important than politics" and calls it the “cause of our time.”
Nine states with abortion restrictions explicitly exempt cases of lethal fetal anomalies, according to the Guttmacher Institute, a research group that supports abortion rights. Even in states with such exemptions, however, doctors say there can be confusion.
“How lethal does it have to be?” Peaceman asked. “Does it have to die within the first few hours? Or the first 30 days?”
At the same time, doctors risk felony convictions that can carry five or 10 years of mandatory prison time if others dispute their conclusions, leading to conservative interpretations of what they complain are overly broad and confusing rules.
Eric Scheidler, the executive director of the Pro-Life Action League, a nonprofit that advocates against abortion, accused “politically motivated physicians” of focusing on “edge cases” to “maintain a broad abortion license.”
Nonetheless, he said he thinks candidates should focus on the majority of abortions that involve healthy pregnancies.
“I really want to see these candidates talk about where we have areas of broad consensus,” he said, adding, "I don’t want to get hung up on these very rare cases.”