Tennessee lawmakers could pass abortion ban exceptions. What would they include?

Tennessee lawmakers will likely formalize a list of medical conditions that qualify for abortion exceptions — but it won’t include mental health conditions or nonviable pregnancies.

The state Senate passed Senate Bill 1004 on Monday. It clarifies that doctors can administer abortion care if a patient’s water breaks early. Other conditions include the life-threatening blood pressure condition known as severe pre-eclampsia and an infection that could cause uterine rupture or a loss of fertility. The language mirrors a court order issued in October, where judges sided, in part, with challengers who argued the medical exception provision was too vague.

The bill’s author, Sen. Richard Briggs, R-Knoxville, explained the bill wouldn’t create new exceptions, only clarify what the existing law means when it refers to “substantial and irreversible” damage to the body.

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The only votes against it were by Democrats, who argued it was insufficient.

“This bill does nothing,” said Sen. Charlane Oliver, D-Nashville. “What we should be doing is really looking at ways to roll back the harm that we’ve done to women in this state, who are now having to flee the state to get medical care, and doctors who are fleeing the state because they can’t provide medical care.”

The measure explicitly states that mental health conditions would not qualify for abortion bans.

Tennessee has one of the highest maternal mortality rates in the country. In 2022, mental health conditions were the leading cause of death, according to the most recent maternal mortality review. It was published in December.

That year, 100 people died while pregnant or postpartum of any cause. These are known as pregnancy-associated deaths. Of those, 45 died from causes closely tied to their pregnancy, known as pregnancy-related deaths.

Nearly a third of pregnancy-related deaths were due to mental health conditions. Drug overdose was the most common immediate cause of death. The second most common mental health-related cause of death was suicide.

Alabama’s abortion ban is the only in the country to include an exception for “serious mental illness.” Several other states have considered law changes to include mental health provisions.

A different bill by Sen. Briggs — Senate Bill 1425 — would have created exceptions for non-viable pregnancies. It stalled out in the committee process. (This means top lawmakers didn’t put the bill up for a hearing, indicating a lack of support.)

About 3% of all pregnancies will involve some kind of fetal abnormality diagnosis, according to a report for U.S. Congress released in 2018.

Briggs has been pushing for this exception for years. He told WPLN and ProPublica that as a surgeon, he cared for patients with fetal anomalies.

“You really have a little baby there you just let sit there until it dies — to get cold and die,” he said. “I think anybody would be affected.”

Vanderbilt released a poll on this issue in the fall. The vast majority of respondents — 82% — supported exceptions for fetal anomalies.

The poll separated respondents by their political affiliations. Self-identified MAGA Republicans supported the exceptions, but at the lowest rate — only 70%.

There are a few reasons that some people who oppose abortion also oppose exceptions for fetal anomalies.

Abortions for this reason can take place later in pregnancy. Although some conditions, such as Downs syndrome or cystic fibrosis, can be diagnosed earlier, major structural anomalies can’t be detected before 20 weeks (when patients undergo an anatomy scan).

Generally, these conditions indicate the fetus isn’t developing correctly. That can mean organs, like the brain or kidneys, never reach full development. It can also mean several bones, like portions of the skull, never develop.

Some states have banned abortions because of fetal anomalies, according to the Kaiser Family Foundation. Lawmakers there argue that the decision amounts to discrimination against the fetus, based on genetic characteristics.

In the lawsuit challenging Tennessee’s medical exceptions, several of the plaintiffs were patients who were denied abortion care in life-threatening emergencies. Each of them learned that their pregnancies weren’t viable.

The lead plaintiff was named Nicole Blackmon. She already had blood pressure issues, which the pregnancy exacerbated. Her doctor told her she was at high risk for a stroke. Her baby was diagnosed with a terminal condition, where all of the organs were developing outside of the body. She was denied an abortion and spent 32 hours in labor, ending in a still birth.