Donald Trump’s recent comments on abortion have been evasive and contradictory. He takes credit for appointing the Supreme Court justices who overturned Roe v. Wade, but says his administration would be “great for women and their reproductive rights.” He first refused to commit to vetoing a national abortion ban, but later said he would. He criticized Florida’s six-week ban as too early, but only a day later said that he would vote against a ballot measure there that would expand abortion rights.
He has, however, been consistent on one position: his opposition to what he calls abortion “after birth,” something he claims his Democratic rivals support. For example, at the September presidential debate, he declared that Vice President Kamala Harris and her running mate, Tim Walz, support the “execution” of babies after they are born. Trump brought up Democratic support for “execution of a baby after birth” again in an X post later that month.
As a debate moderator noted, killing a baby after birth is illegal in all states. What Trump appears to have in mind, and to be disparaging, is perinatal palliative care (PPC)—a crucial medical service aimed at improving quality of life for women and their babies after a severe fetal diagnosis or extreme prematurity. Established ethics guidelines govern who is eligible based on the specifics of a diagnosis, a baby’s chance for survival, and what complications the baby is likely to suffer. PPC can begin at diagnosis during pregnancy, and include standard prenatal care in addition to psychological, emotional, and mental-health support for the parents. If the baby is born alive, the care continues until the infant’s death.
The thing to understand about perinatal palliative care is that no health-care provider or parent ends the baby’s life before or after birth. It’s not an execution, regardless of Trump’s claims. Parents who choose perinatal palliative care are choosing to forgo life-extending interventions, which can inflict or extend their child’s suffering, seeking instead to maximize quality of life for their child when survival is impossible or unlikely.
[Emma Camp: Yes, third-trimester abortions are happening in America]
The bitter irony of Trump’s attacks is that anti-abortion advocates have long pushed PPC as the alternative to abortion for such pregnancies. For instance, Americans United for Life created a policy guide and model legislation called the Perinatal Hospice Information Act in 2018. Following that model legislation, numerous states passed laws requiring abortion seekers to be notified of options for perinatal palliative care before they could receive an abortion. These laws essentially advertised PPC as protecting women because, proponents argued, PPC is less psychologically damaging than abortion. An anti-abortion advocate told a local newspaper in Missouri that “the grieving process is actually better for the woman by actually going ahead and giving birth,” rather than having an abortion. (Research suggests that the psychological outcomes and feelings of regret are the same.)
With PPC available as an option, some anti-abortion leaders shamed women for choosing abortion. For instance, Pope Francis blamed a “culture of rejection” that labels children as “incompatible with life” when they should really be “welcomed, loved, and nurtured.” Perinatal palliative care became the answer for what “good” mothers do when faced with such a diagnosis: not “forsake the child but allow the little one to feel human warmth and love,” and appreciate the “gift of time” with their baby first during pregnancy and later when he or she dies.
That sentiment was on display late last year when Kate Cox sued Texas, seeking a declaration that the state abortion ban’s life-of-the-mother exception applied to her. Cox’s baby had a fatal condition known as Trisomy 18; continuing the pregnancy could have destroyed her chances at having another living child, because of her health risks and prior Cesarean sections. But the Texas Supreme Court rejected her claim, and Cox left the state to obtain abortion care. Texas Right to Life, a prominent anti-abortion group, disparaged Cox’s lawsuit, saying that her child was “uniquely precious” and that the “compassionate approach to these heartbreaking diagnoses is perinatal palliative care, which honors, rather than ends, the child’s life.”
In the post-Dobbs era, most states that had once used PPC as a tool to dissuade women from abortion don’t need to do so anymore; those states have banned abortion. Most states with abortion bans lack an exception for fetal anomalies, and when such an exception exists, it is only for a tiny subset of diagnoses. Thus, people in these states are now being forced to continue their pregnancies, enduring the risks and burdens of pregnancy only to watch their child die.
This means that the need for perinatal palliative care is growing dramatically. A recent study found a 13 percent rise in infant mortality in Texas in 2022, after its six-week abortion ban went into effect in late 2021. (The rest of the country saw a 2 percent increase during that same period.) The biggest jump was in infant deaths due to congenital abnormalities, which rose by nearly a quarter. But many of the states that have restricted abortion have done little or nothing to expand access to PPC for those desiring it. And now that state abortion bans have eliminated the need to pressure families to not choose abortion, the anti-abortion movement may be rethinking its support for palliative care.
[Read: Abortion isn’t about feminism]
Trump, for his part, portrays perinatal palliative care as something callous and murderous. As he put it at a 2019 rally, “The baby is born and you wrap the baby beautifully and you talk to the mother about the possible execution of the baby.” At least according to Trump, parents who choose perinatal palliative care are killing their child, acting just as reprehensibly, in his view, as someone who chooses an abortion.
Trump’s comments make clear that in the post-Dobbs world, there is no right answer for pregnant people facing a devastating fetal anomaly. A mother, apparently, should not only put her body on the line to grow and birth a child who will die in her arms, but force that child into aggressive interventions that may only cause and prolong the child’s suffering.
The most empowering solution for families in such a situation is to provide them with accurate, neutral, and comprehensive counseling regarding their options—abortion, perinatal palliative care, and life-prolonging care. Each path can be justified by a parent’s compassion and love, and each has been chosen by good parents, doing the best they can for their families in an incredibly difficult situation. Donald Trump’s decision to use his platform to stigmatize and berate families in crisis shows how deeply he misunderstands the issue—and, more appalling, his failure to muster any compassion at all for the people living through it.
theatlantic.com