Rape-Related Pregnancies in the 14 US States With Total Abortion Bans

Samuel L. Dickman; Kari White; David U. Himmelstein; Emily Lupez; Elizabeth Schrier; Steffie Woolhandler

doi:10.1001/jamainternmed.2024.0014

Research Letter

Health and the 2024 US Election

January 24, 2024

Rape-Related Pregnancies in the 14 US States With Total Abortion Bans

Samuel L. Dickman, MD¹; Kari White, PhD²; David U. Himmelstein, MD³; et al Emily Lupez, MD⁴; Elizabeth Schrier, MD⁵; Steffie Woolhandler, MD, MPH³

Author Affiliations Article Information

¹Planned Parenthood of Montana, Billings, Montana
²Resound Research for Reproductive Health, Austin, Texas
³Hunter College, City University of New York, New York
⁴Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
⁵Department of Medicine, University of California, San Francisco

JAMA Intern Med. 2024;184(3):330-332. doi:10.1001/jamainternmed.2024.0014

Full Text

Many US women report experiencing sexual violence, and many seek abortion for rape-related pregnancies.¹ Following the US Supreme Court’s 2022 Dobbs v Jackson Women’s Health Organization (Dobbs) decision overturning Roe v Wade, 14 states have outlawed abortion at any gestational duration.² Although 5 of these states allow exceptions for rape-related pregnancies, stringent gestational duration limits apply, and survivors must report the rape to law enforcement, a requirement likely to disqualify most survivors of rape, of whom only 21% report their rape to police.³

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7 Comments for this article

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January 27, 2024

Abortion bans

Daniel Krell, M.D. | Retired PCP

In my practice, I had seen too many children exhibiting consequences of having been unwanted; there were also significant consequences for families with marginal incomes and pre-pregnancy dysfunction, with another child. The mother of one of my adult patients ended her life, upon finding herself pregnant for the 5th time when my patient was a child.

The severe abortion bans negatively affect women of childbearing age. They are particularly onerous for pregnant rape survivors and, especially, children resulting from rape who now number in the thousands where there are strict bans.

I expect that this politically-driven horror will be with us for a long while. One thing that might offer some amelioration are the programs that allow safe, anonymous surrender of infants at prepared, 24-hour, sites, such as fire stations.

This might provide multiple benefits: it increases the probability of the infants and pregnant women surviving (read infanticide, complications of illegal/self-induced, dangerous abortions] or abuse, and being in a more welcoming family; it facilitates documentation of one effect of the abortion bans; and it allows demonstration by “pro-life” supporters of the bans to actually being “pro-life,” rather than just pro-birth. Such programs should be widely promoted and available; a small step but something better than the numerous harms, for these times.

CONFLICT OF INTEREST: None Reported

January 25, 2024

Incomplete and Misleading Research

Ralph Delgado, MD | Primary Care Physician

According to FBI statistics, 127,258 rapes were reported to police departments in 2018; there is documented underreporting of rape with suggestions that only 1/3 of rapes are reported.
If we accept that, there were approximately 450,000 rapes in the entire United States in 2018. Yet this study estimated that there were 519,981 rapes in the 14 states that implemented abortion bans. The estimates in this study certainly don't pass the "smell test".

The study neglects to review the amount of number of pregnancies due to rape in the remaining 36 states; a complete review would have compared the number of pregnancies as well as how many live births occurred in the remaining 36 states.

The authors biases are all too evident and I suggest the editor published this to make some headlines, which indeed it did.

CONFLICT OF INTEREST: None Reported

January 28, 2024

Likely error in calculation due to incorrect citation and incorrect variable

Waris Chiranand | University of Texas

Paper cites "Lifetime rape-related pregnancy rate, 14.9% (CDC 2016/17) " and uses it for primary calculation and headline numbers.

However the CDC source is a victimization survey not dealing with pregnancy rate.

Instead, the likely correct source is the first source cited Basile et al (2018), which directly deals with lifetime rape-related pregnancy rate, "Almost 2.9 million U.S. women (2.4%) experienced rape-related pregnancy during their lifetime."

Instead, the 14.9% was likely pulled from the lifetime vaginal rape rate, resulting in incorrect calculations.

This results in a 14.9%/2.4% error in pregnancies resulting from rapes across the board, or a 620% error, reducing the total number of calculated rape-related pregnancies to 12,000.

CONFLICT OF INTEREST: None Reported

February 2, 2024

Response to Dr. Ralph Delgado and Waris Chiranand

Samuel Dickman, MD | Planned Parenthood of Montana

Dr. Delgado cites FBI data to suggest that the estimated 519,981 rape survivors in states with total abortion bans is implausibly high. The CDC data, which served as the basis for our estimates, is widely considered more accurate[1] than the FBI figures, which only encompass rapes reported to law enforcement agencies. Even accounting for that limitation, as Dr. Delgado did, still yields an undercount when compared with the most recent CDC data (from 2016-2017). That survey indicated that 2,857,000 women (and 340,000 men) were raped in the previous 12 months.[2] The CDC figures were obtained from survivors’ self-report of rape that were collected in a survey that used trained interviewers, multiple questions about non-consensual sexual contact, and an interview strategy designed to protect respondents’ safety, privacy, and comfort in responding to questions about traumatic and highly stigmatized life events.[3]

Our study focused on states with total abortion bans (vs all states) because we were specifically interested in estimating the number of survivors of rape in these states. The data we analyzed did not provide information about pregnancy outcomes.

Waris Chiranand suggests that we overestimated rape-related pregnancies in states with total abortion bans, but this apparent difference is related to the denominator used in the calculations. Researchers have estimated that nationwide between 2,872,000[4] and 3,422,000[5] women experienced rape-related pregnancy during their lifetime. The 2.4% estimate from Basile et al[4] that Chiranand cites is the rape-related pregnancy rate among all US women, not just survivors of rape. According to the CDC data we used, the estimated lifetime risk of pregnancy among survivors of rape is 14.9%.[2] Our analysis conservatively adjusted the figure for survivors of rape downward to account for the difference between annual and lifetime rape-related pregnancy rates.

We recognize that some of the terminology in our report was imprecise and left the impression that our estimate of the number of persons reporting a rape was the number of those who reported a single forced vaginal penetration. The CDC data on rape incidence, on which we based our estimates, quantified the number of persons who reported rape over a 12-month period, which may involve multiple incidents during that time, e.g., in cases of rape by an intimate partner or family member, which represent the majority of rape incidents.[2] We have requested a correction to clarify the terminology in our article. This correction does not affect the calculations or implications of our study: that an estimated 64,565 women and girls have experienced rape-related pregnancies in states with total abortion bans remains unchanged.

Samuel L. Dickman, MD, Kari White, PhD, David U. Himmelstein, MD, Emily Lupez, MD, Elizabeth Schrier, MD, and Steffie Woolhandler, MD, MPH

References
1. National Research Council. Estimating the incidence of rape and sexual assault. Washington, DC: The National Academies Press, 2014.

2. Basile KC, Smith SG, Kresnow M, Khatiwada S, Leemis RW. The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Sexual Violence. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2022.

3. Kresnow M, Smith SG, Basile KC, Chen J. The National Intimate Partner and Sexual Violence Survey: 2016/2017 Methodology Report. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2022.

4. Basile KC, Smith SG, Liu Y, et al. Rape-related Pregnancy and Association with Reproductive Coercion in the U.S. Am J Prev Med. 2018;55(6):770-776.

5. D'Angelo DV, Liu Y, Basile KC, Smith SG, Chen J, Friar NW, Stevens M. Rape and Sexual Coercion Related Pregnancy in the United States. Am J Prev Med. 2023 Love 5;S0749-3797(23)00442-7.

CONFLICT OF INTEREST: The authors have no additional disclosures

April 15, 2024

Number of Estimated Rape-related Pregnancies is Absurd and Obviously Totally Incorrect.

Christina Land, Biomed & Statistics | n/a

Let's say for instance, we go by the figure of 450,000 estimated rapes of females per year.

Let's assume that 80% of these rapes are of women of childbearing age. That leaves 360,000.

According to CDC.gov, 64.9% of women of childbearing age use hormonal contraceptives, leaving 35.1% not using, or 126,360 of these victims.

Women on average are fertile for 3 days out of an average 28 day menstrual cycle. So 10% of the time, or 12,636 women.

Couples trying for a baby take on average at least a year to succeed. So let's call that a 9% chance of a pregnancy each month, so approximately 1137.

The estimated number of rape-related pregnancies per year, based on your estimate of 450,000 rapes of women per year, is much closer to 1,000 than 65,000.

CONFLICT OF INTEREST: None Reported

October 15, 2024

Contraceptive Access and Pregnancy Risks in States with Abortion Bans

Michael Retoff, B.S. / B.B.A. |

Christina Land brings up important points about contraceptive use, but access to birth control can be limited in states with near-total abortion bans, especially for low-income and rural populations. The 64.9% statistic she referenced reflects a national average, which may not apply uniformly to the 14 states in question, as these states often have reduced access to contraception.

For example, some state abortion bans define pregnancy from the moment of fertilization, which can create confusion about certain contraceptives, potentially limiting access to methods like emergency contraception or IUDs due to misinformation or legal concerns.

Additionally, trauma from rape and limited access to emergency contraception can increase pregnancy risk, making it more complex than typical fertility models suggest.

References
1. National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Sexual Violence. CDC, 2022.

2. KFF. The Right to Contraception: State and Federal Actions, Misinformation, and the Courts, 2023.

CONFLICT OF INTEREST: None Reported

November 7, 2024

Doubt amount comments.

Erica Stark |

Interesting that most of the men and Christine view the number as high, while data extrapolation supports that number or even a higher number. In order for a rape to be counted in a banned state, most must be reported to police. Many don’t want to do that as they live with the rapist (family).
This article expresses that well.
https://www.npr.org/sections/health-shots/2024/01/24/1226161416/rape-caused-pregnancy-abortion-ban-states

CONFLICT OF INTEREST: None Reported

Rape-Related Pregnancies in the 14 US States With Total Abortion Bans

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