How Would Monitoring Pregnancies to Prevent Abortions Work in Practice?

In a recent Time Magazine interview, Donald Trump was asked about monitoring pregnancies to ensure women weren’t having abortions.

“Do you think states should monitor women’s pregnancies so they can know if they’ve gotten an abortion after the ban?”

“I think they might do that. … You’ll have to speak to the individual states.” — Donald Trump

So, let’s unpack how that would work in practice. To be effective, individual states would have to know when every woman became pregnant and require regular checkups to determine the health of the mother and the viability of the fetus. Knowledge of the mother’s health isn’t out of concern for her; it’s to make sure there’s no trickery about underlying conditions and medical excuses citing the “health of the mother” to have an abortion.

“Monitoring” must logically begin by identifying all women capable of giving birth and tracking them as long as they can conceive. Hospitals and midwives will be required to report all female births and report them into the system. Females born before the regulation must register on or before their 8th birthday.

Visitors to states will undergo a screening process to ensure they don’t sneak into the state undetected and unregistered. Stations will be set up along the border and at airports, ports, and train stations to issue temporary registrations to women. Upon leaving, women can request to be removed from the rolls. States may work together to form reciprocal agreements to recognize each other’s women. States can work that out between themselves as it is a state’s rights issue.

Every time a woman undergoes a blood test, the results will be sent to the state where the hCG levels will be recorded. Women will be required to take the Quantitative hCG test instead of the Qualitative hCG test to ensure greater accuracy. Home pregnancy tests will still be allowed. New strips will be issued that will automatically transmit results to the state for follow-up. A state-licensed doctor will conduct a home visit within ten days to determine the accuracy of the test.

Women over two weeks late for their period will notify the state. Women feeling any combination of breast tenderness, fatigue, nausea, and headaches are also required to report. Women with a history of migraines or chronic stomach upset can get an exemption, but any two other factors mandate reporting.

States will have different times up to which abortion may be legal. Monitoring will be critical in determining how long a woman is pregnant. Some states allow abortion within the first six weeks, others up to 24 weeks, some have no limits, and others ban almost all abortions at fertilization. The chart below needs updating as Florida has just changed from 15 to 6 weeks. Depending on the state, abortions may not be allowed until an official determination of the length of pregnancy is determined. That determination may take as long as four weeks to obtain.

Expectant mothers will be required to follow up with their doctors every month to track the status of the unborn child. Any woman previously identified as pregnant who is no longer pregnant must produce a notarized statement giving the reason why, like a miscarriage or mistaken pregnancy determination. The state may investigate for potential prosecution should they question the statement.

By now, you may be considering the cost of all the additional infrastructure and bureaucracy: inspection stations at border crossings and a new department in each state dedicated to abortion monitoring. There’s the extra paperwork for doctors and midwives, along with the costs of home pregnancy tests that transmit results. There will be additional doctor visits, which will likely not be covered by Medicaid or state programs. Not to worry, the additional costs will all be paid by increased taxes paid by the extra babies born. That theory isn’t economically sound, but it makes as much sense as “trickle-down economics” or massive tax cuts for the rich.

Maybe you believe that monitoring pregnancies would never happen. You probably thought the Supreme Court would never get rid of Roe v. Wade or revert to 1864 laws, either. To be fair, the Arizona legislature did repeal the 1864 law after several votes. We’re well past assuming what anti-abortion forces would never do. After the first few years, monitoring will just be a fact of life. They will hardly notice.

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This post was previously published on The Polis.

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