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Delayed, Denied, Deficient
How Exceptions Fail to Ensure Critical Care Under Georgia’s Abortion Law.
We know that “exceptions” do not work or make abortion bans safe.
Abortion bans impact miscarriage care medical crises assault survivors healthcare providers all pregnant people
Background
Georgia’s HB 481, originally enacted in 2019, went into effect on July 20, 2022, shortly after the Dobbs v. Jackson Women’s Health Organization US Supreme Court decision overturning Roe v. Wade. The law limits abortions after detectable fetal cardiac activity (around six weeks of pregnancy) but includes several “exceptions” for specific cases, including conditions where abortion is necessary to prevent death or substantial impairment of the pregnant person, pregnancies with fetal anomalies incompatible with life after birth, pregnancies resulting from rape or incest, miscarriage and ectopic pregnancy management, and sexual assault exceptions (which require the pregnant person to file a police report.).
In response to growing evidence and concern from community leaders, RISE researchers and Amplify Georgia Collaborative co-led a study to systematically document and describe experiences of care for pregnancies that might meet the criteria for exceptions under the law. From August 2024 to December 2025, we conducted 25 interviews with patients, clinicians involved in pregnancy care, and community organizations and agencies that support pregnant people and survivors of sexual violence. We sought to understand the extent to which exceptions included in the law may facilitate access, and how and why exceptions may still result in delays and denials of pregnancy-associated care.
The Findings
Access to care is hampered by the challenges of applying HB 481’s language to real-world situations.
Patients’ care in this situation now depends on intensive documentation and coordination between multiple healthcare providers and multiple levels within a health system, or even between health systems. Critical care is delayed and sometimes out of reach.
This exception entails repeatedly disclosing sexual assault to access care, a high burden in itself.
The requirement of a police report is another significant, often insurmountable barrier. Many patients don’t want contact with law enforcement; some see it as risky and unsafe to other aspects of their lives, like housing, financial security, and family relationships.
Even when they do disclose to providers, only a small minority are able to access care under this exception, due to challenges or hesitancy initiating a police report.
Even though HB481 specifies that miscarriage care is not restricted, it often causes barriers to timely treatment for early and later pregnancy loss, because pregnancy care is nuanced.
A “bright line” isn’t always present to determine the moment a pregnancy has become non-viable, but the patient’s condition can deteriorate quickly if left untreated. Waiting for a patient who is having a pregnancy loss to also meet the “threat to life” standard can result in dangerous delays and traumatic outcomes.
Because of HB 481, providers feel compelled to adopt practices that don’t meet established standards of care. This includes delaying care until patients become very ill. So patients often have “near misses” – serious complications that were only addressed in time to prevent death.
HB 481 means healthcare providers could face up to 10 years in prison and loss of their professional license for giving proper care to a patient. They struggle with going against their medical expertise and moral and ethical obligations in order to mitigate legal risks.
Even with written “exception” language, pregnant people with life-threatening conditions, who experience medical emergencies, or who suffer pregnancy losses, are often unable to receive care until they’re close enough to death that providers are finally permitted to proceed with treatment.
The potential for criminalization is interfering with care.
Pregnancy care in real-life situations is complex
In this qualitative research, we heard from individuals about their experiences in navigating care under HB 481. Names are pseudonyms, and we’ve removed specific details in the retelling of these experiences to retain anonymity.
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Georgia's six-week abortion ban makes it hard for healthcare providers to care for their patients.
The law is so unclear that many providers don’t know if they can legally treat pregnancy complications, leading to a shortage of OBGYNs, but also of pediatricians and future doctors of all specialties. When healthcare workers are legally prevented from following their profession’s standard of care, some decide to leave Georgia for a state where they can receive fundamental training in their field and provide the full range of care their patients may need.
Healthcare providers should be able to provide a full range of options to patients without fear of punishment.
The Reproductive Freedom Act (RFA)
What are we doing about restrictions in Georgia?
The Reproductive Freedom Act campaign is working to make abortion care accessible to all Georgians. The RFA will:
- Enshrine fundamental protections for reproductive freedom into Georgia law.
- Repeal medically unnecessary and harmful abortion restrictions that create barriers to care.
- Expand access to abortion care.
Amplify Georgia Collaborative