Since the Supreme Court’s decision to overturn abortion rights over a year ago, there has been confusion in some Republican-led states regarding the implementation of loosely-worded bans and how exceptions should be interpreted.

Advocates have praised these exceptions, hidden within laws that limit abortion, as being adequate to safeguard the woman’s life. However, when put into practice in emotionally charged scenarios, the outcomes are often ambiguous.

Kaitlyn Kash, one of 20 women in Texas who were denied an abortion, is part of a lawsuit against the state. The lawsuit aims to clarify the laws surrounding abortion, which are often seen as binary but actually have many nuances. This type of lawsuit is becoming more common in other parts of the country as well.

Lawmakers in various states are increasingly urged to address these inquiries by modifying legislation during the upcoming legislative sessions, which will begin in the majority of states next month. However, it is uncertain how or if they will do so.

In June 2022, the 1973 Roe v. Wade ruling was overturned by the Supreme Court. Prior to this, almost all states permitted abortion up until the point where the fetus could survive outside of the womb, which is typically around 24 weeks of gestational age or about 22 weeks after conception.

However, the recent ruling has allowed states to implement stricter regulations or completely ban certain actions. Some states had already enacted similar laws in preparation for this decision.

At present, 14 states have implemented restrictions on abortion throughout the entire duration of pregnancy. Two additional states have temporarily suspended these restrictions due to legal decisions. Furthermore, two states have imposed bans that go into effect when a heartbeat can be detected, which typically occurs around six weeks into pregnancy, often before women are aware of their pregnancy.

Each state ban has a provision that allows abortion under at least some circumstances to save the life of the mother. At least 11 — including three with the strictest bans — allow abortion because of fatal fetal anomalies, and some do when the pregnancy was the result of rape or incest.

However, a clause in a legislation passed by the United States Congress in 1986 and approved by Republican President Ronald Reagan stated that abortion must be accessible in cases where a pregnant woman’s life is in danger due to a medical emergency.

However, confusion surrounding the implementation of this rule and other exemptions outlined in state legislation has intensified the emotional distress and anguish that certain women endure when confronted with significant medical problems but unable to obtain abortion services in their own states.

The situation involving Katie Cox, a woman from Texas who filed a lawsuit for immediate access to abortion during a difficult pregnancy, gained widespread attention this month after being denied by the state’s highest court.

Jaci Statton has lodged a complaint in Oklahoma, alleging that the state has violated a federal regulation. According to court records, she was informed by doctors that her pregnancy was not viable and that her life was not in immediate danger. As a result, she claims she was instructed to wait in a hospital parking lot until her condition deteriorated enough to qualify for life-saving treatment.

Nicole Blackmon shared with journalists in Tennessee that a 15-week ultrasound revealed that her baby’s vital organs were developing outside of its stomach and the baby was not expected to survive. Despite this, her medical team informed her that she did not have the choice to undergo an abortion. As a result, she gave birth to a stillborn baby due to her inability to afford out-of-state travel for an abortion.

The ambiguity surrounding Tennessee’s ban on abortion has sparked Senator Richard Briggs, a Republican, to propose changes to the law during the 2024 session. It remains uncertain how much support the proposal will receive in the statehouse, which is controlled by the GOP and has several members up for reelection.

Earlier this year, Republicans created a very limited exception, but Briggs, a doctor, believes that the law still does not adequately support women and doctors. He advocates for the inclusion of a list of diagnoses for when abortion may be necessary and for the protection of women with pregnancy complications that could lead to infertility if they do not receive an abortion.

In 2023, other states attempted to alleviate the confusion, but proponents argue that their efforts were not entirely successful.

This year, legislators in Texas included a clause that grants doctors legal immunity for terminating pregnancies in situations of early membrane rupture, also known as water breaking, or ectopic pregnancies, which may result in hazardous internal bleeding.

Advocates on both sides expect an increase in the number of legislatures considering amendments or clarifications to abortion restrictions and definitions in 2024. However, there have been little to no filings of such measures at this time.

“Denise Burke, a senior counsel with Alliance Defending Freedom, a legal advocacy group for conservative Christians that has been involved in numerous anti-abortion lawsuits, raised the question of what constitutes an abortion and when it can be considered an emergency. She suggested that there may be a need for further clarification in certain situations.”

In states where Democrats hold power, legislators are likely to advocate for relaxed abortion regulations and increased availability.

In the current year, Maine joined six other states in not having a set time limit for obtaining an abortion during pregnancy.

According to Greer Donley, a faculty member of the University of Pittsburgh Law School and an authority on abortion laws, there may be a movement towards further revisions similar to this: “There is a growing concern about the necessity of having any boundaries in place at this time.”

The situation in Texas is clear-cut, as there are no anticipated revisions in 2024 due to the absence of scheduled legislative sessions.

A group of 20 women, including Kash, and two doctors in Texas are currently involved in a lawsuit with the state’s Supreme Court in an effort to define the circumstances in which abortions should be permitted. The women had previously been denied access to abortions.

Kash, who was already a mother to one child, was filled with happiness at the idea of sharing the news of her pregnancy with loved ones. However, a routine ultrasound at 13 weeks revealed that her baby had a serious condition called skeletal dysplasia, which impacts the growth of bones and cartilage. Unfortunately, her baby was not expected to survive birth or would likely experience suffocation shortly after being born.

“Is this the appropriate time to discuss ending the treatment?” Kash inquired of her doctor.

She remembered that he advised her to seek a second opinion from another state.

She was not in immediate danger of her health declining, therefore she did not meet the requirements for any exceptions that would allow her doctor to perform an abortion. As a result, she traveled to a different state to legally terminate her pregnancy.

During last month’s court proceedings, a legal representative for the patients informed the judges about the uncertainty surrounding the case.

Molly Duane, a lawyer from the Center for Reproductive Rights, stated that although there is a medical exemption to the prohibition, its meaning is unclear and the state has not provided any information.

According to Beth Klusmann, a deputy attorney general, the law provides direction by stating that doctors must exercise “reasonable medical judgment” when determining if a pregnant woman’s life is in danger.

She stated that there will always be difficult decisions at the boundaries of any abortion restriction.

Marc Hearron, a legal expert at the Center for Reproductive Rights who is heading the Texas lawsuit, expressed doubt in the ability of lawmakers nationwide to handle this issue properly.

According to him, legislators have a history of not taking heed to doctors’ opinions. We are not relying on legislators to act in the best interest.