What Donald Trump, and most Republicans, don't understand about abortion "exceptions"

Donald Trump said during a town hall on NBC's Today show Thursday that he would "absolutely" change the Republican platform to allow exceptions to abortion bans in cases of rape, incest, or saving the pregnant woman's life.

"The Republican platform every four years has a provision that states that the right of the unborn child should not be infringed," Today host Savannah Guthrie said. "And it makes no exceptions for rape, for incest, for the life of the mother. Would you want to change the Republican platform to include the exceptions that you have?"

"Yes, I would. Yes, I would. Absolutely," Trump said. "For the three exceptions, I would."

"Would you have an exception for the health of the mother?" Guthrie followed up.

"I would leave it for the life of the mother," Trump said. "But I would absolutely have the three exceptions."

What these abortion exceptions mean for the Republican party

These exceptions — "rape, incest, and life of the mother" — are sort of a standard trinity in anti-abortion lawmaking. Most laws that ban federal money from being used to fund abortions, like the Hyde Amendment and the Helms Amendment, still allow exceptions for those three specific cases.

Republicans disagree on whether even these exceptions, particularly rape and incest, should be allowed. Ted Cruz, for instance, opposes rape and incest exceptions. But Sen. Lindsey Graham (R-SC) has said he thinks opposing these exceptions is both morally wrong and a bad political move for the GOP.

When they actually write anti-abortion legislation at the federal or state level, Republicans (and the occasional pro-life Democrat) usually include rape and incest exceptions (but definitely not always). Most Republicans either don't think it's reasonable to ask a woman or girl to carry her rapist's baby to term, or do think it's reasonable but recognize that it's politically necessary to compromise on the point.

So it's pretty striking that the official GOP platform basically endorses the kinds of "personhood" rights for fertilized eggs, without even a stated exception to save a woman's life, that have proved too radical even for conservative voters in states like Mississippi.

These exceptions are actually a major human rights problem

First of all, it's important to note that rape and incest exceptions don't work very well in practice. For instance, more than half of eligible low-income women who have insurance through Medicaid never actually get the reimbursements they are entitled to, even for an abortion that should be covered under one of these three dire circumstances.

But the biggest problem with these three standard exceptions, as Guthrie alluded to, is that they don't include an exception for the woman's health.

This is a big deal. It's a huge oversight in abortion policy that not only has dire human rights consequences, it's also unconstitutional.

Under the Supreme Court's 1973 decision in Roe v. Wade, any abortion restriction is supposed to include an exception for a woman's health. And it has to be a broad exception, because a doctor needs to be able to exercise her best medical judgment on whether an individual abortion is medically necessary or advisable. It's just not the kind of thing you can legislate neatly without causing problems for somebody who has a condition that lawmakers didn't think of ahead of time.

Republicans sometimes oppose exceptions for a woman's health because they worry that women will lie about having a mental health issue like suicidal depression so that she can get the abortion she wants. So when an anti-abortion bill does include a health exception, it's often narrowly worded to only count something like the "serious risk" of a "substantial and irreversible physical impairment of a major bodily function."

But when there's no health exception — or when a health exception is so narrowly tailored that it ties doctors' hands — the consequences for women can be serious.

Just look at the problem of miscarriage management in Catholic hospitals in the United States for an example of how this plays out in practice. Because of the Catholic Church's strict anti-abortion rules, some doctors have refused to induce labor for a woman having a miscarriage until she actually develops sepsis — in other words, they have to wait until her life is literally in danger and can't do anything until then even if they know it's risky.

This sort of thing literally kills women in countries like Ireland, whose strict anti-abortion laws lack adequate health exceptions.

And there are all kinds of less critical, but still very serious, conditions where an abortion is the safest option to protect a woman's health, even if it may or may not save her life. Some women get cancer while they're pregnant and stand a much higher risk of dying if they don't get an abortion and start chemotherapy right away. Heart conditions, kidney conditions, lupus, diabetes — these issues and more can make a pregnancy "high-risk," and sometimes so high-risk that it's not worth it to try to carry the pregnancy to term.

But these risks aren't always absolutely knowable, and thus they are extremely difficult to legislate responsibly. How much "risk" is enough risk to justify an abortion under laws like these? How much risk can we legally require women to bear for the sake of carrying a pregnancy to term? And how much more risk than normal will doctors tolerate when they are threatened with years in jail if they make the wrong call?

This is what happens when abstract moral principles collide with concrete medical practice. It's not pretty.