A primer on the surge in abortion bills

The rush of Republican-controlled states to mount a challenge to the Supreme Court's landmark Roe v. Wade ruling legalizing abortion nationwide has sparked confusion about what these new laws actually do. Here's what you need to know.

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On Friday, Missouri lawmakers passed a strict anti-abortion bill that will criminalize the procedure at eight weeks of pregnancy

Missouri's Republican-controlled House voted 110 to 44 send the measure to Republican Gov. Mike Parson for his approval. Parson, who has vowed to make Missouri "one of the strongest pro-life states in the country," is expected to sign it into law.

The "Missouri Stands for the Unborn Act" would ban abortions before many women know they are pregnant, with no exceptions for rape or incest.

The vote came just hours before the state's legislative session was set to end, and it was preceded by an emotional debate in the House, where some lawmakers recounted their own experiences with abortion.

Setting the stage

Ten states have tightened restrictions on abortions this year, and similar measures are pending in other states. The new laws have prompted questions about whether women who have abortions could be punished and why some of the pieces of legislation are called "heartbeat bills," among other topics.

These restrictions generally are meant to provoke legal challenges that ultimately elevate the issue to the Supreme Court.

"I have prayed my way through this bill," Alabama state Rep. Terri Collins, a Republican who sponsored that state's abortion ban, said on Tuesday. "This is the way we get where we want to get eventually."

Now that two Trump-appointed justices are on the Supreme Court, social conservatives see potential for a reversal of the court's 1973 decision in Roe v. Wade - although the court tends to make incremental changes to its interpretation of law, instead of dramatically overturning precedent.

New York and Vermont, meanwhile, have enacted protections of abortion rights. In Illinois, an abortion-rights measure has stalled in committee.

Alabama's new law

The bill signed Wednesday by Alabama Gov. Kay Ivey, a Republican, prohibits abortion in almost every circumstance and is considered the most restrictive abortion law in the country. The legislation makes exceptions only for the health of the mother and for fetuses with "fatal anomalies" that make them unlikely to survive outside the womb. Rape and incest are not exceptions to Alabama's ban.

Punishments

The laws in Alabama and Missouri specifically exempt women from being criminally liable, said Katherine Kraschel, the executive director of Solomon Center for Health Law and Policy at Yale Law School.

Georgia's new law, she said, is less clear because it defines a fetus or embryo as an unborn child.

Alabama's law targets doctors, who can be prosecuted for performing an abortion and punished by up to 99 years imprisonment.

Carol Sanger, professor at Columbia Law School, said such penalties on doctors were "just another way to make women frightened" and create "more disincentives for physicians and residents to take up this practice."

The Georgia law, which is set to take effect in January, also says that doctors who perform abortions will be prosecuted, but it is more vague about women.

The measure could not be used to successfully prosecute women, according to Planned Parenthood's Staci Fox. But if a woman had a miscarriage, she could be pulled into an investigation looking at whether someone performed an illegal abortion on her.

"You don't want a woman to be forced to prove how she lost her baby," said Sanger.

Georgia's law does not unequivocally say that women are exempt, but legal experts point to other areas of Georgia's penal code that have specific defenses for women, including those who miscarry.

Heartbeat provision

Some legislation, like Georgia's, prohibits abortion after the detection of what the bills call the fetal heartbeat, which usually happens about six weeks into pregnancy. That is about two weeks after a woman's first missed period, when many women do not yet know they are pregnant.

Supporters of this type of abortion ban refer to the legislation as "heartbeat bills," while many abortion rights activists say the term is inaccurate because an embryo's heart has not fully formed at that point.

An ultrasound will usually show electric activity in an embryo's forming heart at about six weeks of pregnancy, said Jen Villavicencio, an OB/GYN and member of the American College of Obstetricians and Gynecologists. She said although that activity is not the same as a heartbeat that pumps blood, she often uses the term "heartbeat" with her patients at that point because they are familiar with that terminology.

Villavicencio said it technically is an inaccurate description.

"I think that when you are legislating biology in this way, you need to be really, really precise," she said.

Why are some people objecting to the six-week cutoff written into these "heartbeat bills?"

Doctors date a pregnancy from the first day of a woman's last period, not from the date when she had sexual intercourse. Most women are at least four weeks pregnant when they discover the pregnancy, Villavicencio said.

Many women do not realize it until the fifth or sixth week, she said, especially if they did not expect to become pregnant. Women are taught to suspect pregnancy if they miss their period, but other factors - like stress, obesity or new medications - can also disrupt a woman's menstrual cycle.

Alternatives

Over-the-counter morning-after pills generally prevent pregnancy when taken within 72 hours of sexual intercourse, Villavicencio said, although the pills are much less effective in women who weigh more than 170 pounds. Emergency contraception that requires a prescription should be taken within five days of sexual contact, Villavicencio said.

Women who want to avoid becoming pregnant, she said, "have a very tight timeline to access emergency contraception over the counter."

Does banning work?

Not significantly. Countries with total or partial bans have an abortion rate of 37 in 1,000 people, while 34 in 1,000 people have abortions in countries with no restrictions on it, according to the Guttmacher Institute, a research and policy organization that advocates for abortion rights.

Expanding access to contraception, however, does correlate with lower rates of abortion, the Guttmacher Institute says. A study by Washington University in St. Louis found in 2012 that giving women free birth control reduces abortion by 62 percent to 78 percent compared to the national rate.

In Illinois

In February, Democrats introduced the Reproductive Health Act, which backers and detractors agree would be the most liberal reproductive health care law in the country.

Democratic Gov. J.B. Pritzker has vowed to "make Illinois the most progressive state in the nation for access to reproductive health care," seemingly indicating he would sign the bill if it arrived on his desk. However, the measure has stalled in committee in both chambers of the legislature.

Supporters of the bill rallied Wednesday for action in Springfield.

"What we saw in Alabama ... must mobilize us," said Sen. Melinda Bush, a Grayslake Democrat who sponsored the measure in the state Senate. "There is a war against women's rights and our ability to make decisions about our own bodies happening across this country."

In opposition, the anti-abortion Illinois Citizens for Ethics Political Action Committee collected 15,774 signatures from churchgoers and submitted them to House Speaker Michael Madigan's office.

"The mask has slipped. Advocates for these bills are not pro-woman - they are putting clinic profits before the safety of women and girls,"

Mary-Louise Hengesbaugh, chairwoman of the committee, said Wednesday. "This is why so many women are getting involved in opposing this harmful legislation."

• Capitol News Illinois contributed to this report.