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Internship Research

Chapter One: Fetal Heartbeat Bill

Introduction: The Fetal Heartbeat bill has been proposed on several occasions by South Carolina legislators. After several failed attempts, the bill has been proposed again by anti-abortion politicians. We know that this bill would be detrimental to women’s rights. In my research of this subject, I have come across several points as to why this bill would not be successful. Before I discuss my findings, here is a brief background on this subject.

Background: The Fetal Heartbeat Protection From Abortion Act was first introduced in January of 2019 in the SC House of Representatives. This bill seeks to amend several sections of the Code of Laws of South Carolina regarding abortion. This is the current stance on abortion as written in South Carolina Law:

Abortions defined as using an instrument or medication with the intent to terminate a pregnancy (other than birth, to preserve a baby’s life or remove a dead fetus) are legal in South Carolina only under the following three circumstances:

In the first trimester with the pregnant woman’s consent.
In the second trimester with the pregnant woman’s consent in a certified hospital or clinic.
In the third trimester when necessary to preserve the life or health of the pregnant woman on the written recommendation of two doctors, and if the basis is mental health then both the two doctors and a consulting psychiatrist must agree in writing the abortion is necessary.

The pregnant woman’s written consent is required for an abortion to be performed in South Carolina. However, if she’s under 17 years and unmarried, the consent of at least one parent, grandparent, or guardian is required, except in medical emergencies or if the pregnancy is the result of incest.
South Carolina has a judicial bypass where the minor can petition the court for the right to an abortion without parental notification. She has the right to court-appointed counsel for this hearing and a guardian ad litem will be appointed. The abortion is to be granted if it’s in the best interest of the child. If the court finds the minor is too immature and the abortion wouldn’t be in her best interest, it’ll be denied. She has a right to appeal in this case.
If denied, the father is identified, he will be ordered to share in the costs of delivery and raising the child. The state may pay for counseling, prenatal care, delivery, and post-natal care.
Either a spouse, parent or legal guardian will have to consent to abortion for a woman found mentally incompetent.

The Fetal Heartbeat Act seeks to amend sections in Chapter 41 of Title 44 in regards to abortions in the Code of Laws of South Carolina. been proposed in the South Carolina House of Representatives multiple times to no success. The question is why do supporters of this bill continue to propose this bill, despite there being more pressing matters that need attention. I believe it is because these individuals feel that passage of this bill could be possible in 2021. While I don't believe this bill has the chances of passage if the following conditions were to occur passage could be possible. The Fetal Heartbeat bill has always passed in the House of Representatives because the Republican party holds majority control. In the Senate, supporters of the bill have not been able to secure the necessary number of votes. Here is where the passage of this bill could be possible. In the 2020 elections, the Democratic party lost three seats in the South Carolina Senate. The Republican Party also gained seats in the House of Representatives. The Republican party now holds a supermajority, which may allow for the passage of the Fetal Heartbeat bill. Currently, the bill has been approved by the Senate's Medical Affairs Subcommittee. If the bill is approved by the Medical Affairs committee, then it will be sent to the Senate floor for voting. Despite the state still suffering from COVID-19, this issue is being discussed again because the Republican party feels that they now have the control needed to pass this bill in the Senate.

Research: In researching this issue, I determined that this bill would ultimately remove a woman's right to continue the pregnancy or not. This bill would seek to prohibit all abortions after six weeks of pregnancy. The issue with this clause is that many women do not know that they are pregnant until after eight- weeks of pregnancy. After interviewing some friends and family members, I determined that the actual identification of pregnancy depends on the individual. My mother discovered she was pregnant at two weeks as she became very ill. For both of my grandmother’s pregnancies, she did not find out until she was seven weeks pregnant. After viewing various pregnancy blogs, some did not find out they were pregnant until they were nine weeks. The implementation of this bill would inhibit women that discover they are pregnant after six weeks from obtaining an abortion.

In my research, I discovered that fetal heartbeat detection is actually a very controversial topic. Do some say a heartbeat can be detected as early as four weeks but is that truly a heartbeat? According to MedlinePlus, the fetal heartbeat cannot be detected until the sixth week of pregnancy. According to The American Heart Association, the fetal heart is not developed until eight weeks gestation. Keeping this information in mind, a medical expert could say that this bill is not medically sound, given that the actual fetal heart is not developed until after six weeks.

Maternal health services in South Carolina are already limited to some individuals. Enacting this bill would force some women to continue a path that they do not want. Maternal health services are already limited in various rural and urban communities. With continuous physician shortages in these areas, women who were forced to remain pregnant due to the limitations of this bill, may not be able to receive proper prenatal or postpartum care. A research article published by the South Carolina Center for Rural and Primary Healthcare stated that "The ratio of OB/GYN to 1,000 residents, at the county level, ranges from 0.043 in Berkeley County to 1.218 in Charleston County (Table 1). The median ratio among counties with a provider was 0.24 (mean 0.31). Ten counties (Abbeville, Allendale, Bamberg, Barnwell, Calhoun, Edgefield, Hampton, Lee, McCormick, and Saluda) have zero providers in their county," (Bennett, Purser, Carter, & Stanek, 2019).

Kentucky and South Carolina are both similar in regards to population, healthcare, and politics. Former Kentucky Governor Matt Bevin actually signed several anti-abortion bills into law, including a fetal heartbeat bill. However, all of these laws have either been temporarily or permanently banned by a federal judge. Considering that Kentucky is also a Republican state, I am not surprised that they would have a similar stance on abortion. Both states equally lack certain maternal and child health services. The main issue is access to maternal health services. If this bill were to be instituted, the state has to make sure that the women who are forced to continue their pregnancy have access to prenatal care. Many individuals do not have transportation, therefore traveling 30 minutes to an hour for prenatal care is not an option. What both of these states should be focusing on improving their maternal and child health services. This bill is a distraction from the real issues our state and the entire country are facing. The state's efforts should be focused on reducing the number of individuals contracting COVID-19, issuing vaccines, and fixing our current economic situation.

Fetal Heartbeat Bill Update/Medicaid

As of January 28, 2021, The South Carolina Senate passed the Fetal Heartbeat bill after three days of deliberation. To recap, this bill would ban all abortions after a fetal heartbeat is detected. A heartbeat is usually detected around six weeks gestation. The only exceptions added to this bill are in the case of rape, incest, fetal anomaly, or possible harm to the mother. The implementation of this bill significantly limits women’s rights, in regards to their bodies.

The problem with this bill is some individuals already have limited access to maternal health services. Rural communities are already experiencing limited access to maternal health services. In 2015, The South Carolina Department of Health and Environmental Control conducted an analysis of maternal healthcare needs in South Carolina. This analysis examined possible risk factors for pregnancy, as well as factors for a positive pregnancy. Influential risk factors for pregnancy include education, income, insurance type, access to care, and racial norms. All of these factors are important, but in light of the recent passage of the fetal heartbeat bill, three of these factors have increased in importance. Income, insurance type, and access to care are factors that influence an individual's ability to seek care. Transportation was listed as a significant barrier to healthcare access.

Many smaller communities do not have maternal health services. Individuals who do not qualify for Medicaid, as well as individuals who do not receive insurance through their employer, are limited in their ability to seek healthcare. Under Medicaid, expectant mothers can receive health care coverage if they fall within the qualifications guidelines. The problem with these guidelines is that many women still do not qualify to receive Medicaid. For example, let's say we have a twenty-year-old woman experiencing her first pregnancy. She has no familial support, no health insurance, the father of the child does not want to be involved, and she only makes about $1,200 dollars a month. Under the guidelines established by the state of South Carolina, she would not qualify for this program. In South Carolina, the state is required to cover ineligible expectant mothers for 60 days after giving birth, but what if the mother is experiencing birth complications past the 60 day period. Advocates for Medicaid expansion have suggested that the coverage period be extended to one year postpartum. This extension would allow the mother to receive the appropriate post-partum for a new mother. Most lawmakers do not understand how important these services are for some individuals. According to the Kaiser Family Foundation, “ For pregnant women who are eligible for Medicaid under the ACA’s Medicaid expansion pathway, states must cover all preventive services recommended by the United States Preventive Services Task Force (USPSTF) including many pregnancy-related services, such as prenatal screening tests and folic acid supplements as well as services in the postpartum period, such as lactation consultants and breastfeeding supplies,” ( Ranji & Gomez, 2020). Problems with lactation and breastfeeding can last well beyond 60 days. If the Biden administration expands Medicaid coverage, this will allow women (who would otherwise not receive care), to receive the proper prenatal and postpartum care.

The passage of this bill is likely to increase the maternal and infant mortality rate in South Carolina, as many women will be unable to seek prenatal care and postpartum care. As of April 2019, The current maternal mortality rate in South Carolina is 24 per 100,000 live births. African- American women the rate is 41.9 per 100,000 live births. A study published in the American Journal of Public Health examined the effects of Medicaid on infant mortality rates. According to the study, “We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non–Medicaid expansion states), stratifying data by race/ethnicity,” (Bhatt & Beck-Sagué, 2018). The results of the study concluded that the infant mortality rate rose in states that did not expand Medicaid. In states with Medicaid expansion, the infant mortality rate declined. The results of this study show how necessary Medicaid coverage is for expectant mothers. It is likely that women will either travel out of state to seek an abortion or attempt ulterior methods to relieve themselves of their pregnancy. I expect that South Carolina will also see a spike in both maternal and infant mortality rates, as we have not expanded Medicaid services.

Fetal Heartbeat Bill Summary: The Fetal Heartbeat Protection From Abortion Act was first introduced in January of 2019 in the SC House of Representatives. This bill seeks to amend several sections of the Code of Laws of South Carolina regarding abortion. This act seeks to ban all abortions after a fetal heartbeat is detected. Supporters of this act state that a fetal heartbeat can be detected at six weeks gestation, but this is not accurate for every expectant mother. For individuals who find out they are expecting after six weeks, they have no choice but to continue with the pregnancy. This bill eliminates a woman's right to choose in regards to her reproductive health. For individuals who live in areas lacking maternal health services, many women have to travel over an hour to seek prenatal care and to give birth. Kentucky has a similar stance on this issue, but they have a wide variety of maternal health services. As of January 28, 2021, The South Carolina Senate passed the Fetal Heartbeat bill after three days of deliberation. This bill poses significant risks for expectant mothers. Expectant mothers are covered under Medicaid for 60 days after giving birth, but many women do not qualify for Medicaid due to new regulations.

Click here to go to Chapter Two - African-American Maternal Health