Abortion Access: Potentially Devastating Consequences for Vulnerable Girls and Women with Intellectual Disabilities and Autism 

An Open Letter to State Legislators

In the wake of the Supreme Court’s Dobbs decision, we are aware that many states are positioned to impose sweeping bans on access to abortion, even in cases involving risks to the mother.

When one thinks of abortion, girls and women disabled by autism and intellectual disability — who may have reproductive capacity but lack capacity to defend against rape, may have little to no ability to speak, and may function at a preschool level — probably don’t come to mind. But those of us parenting or providing healthcare for such girls and women can only shudder as we ponder what may now happen to many of our vulnerable loved ones, patients and clients in the wake of Dobbs.

The CDC estimates that 1 in 145, or .69 percent, of girls (as of the 2018 surveillance of 8 year-olds) has autism (the rate among boys is 1 in 34), with well over half suffering from intellectual disability (ID) or borderline intellectual disability, as well. Beyond that, at least 1% of our population has intellectual disability, without autism. It is well-known that medical, psychiatric, and behavioral comorbidities abound in ID and autism, and many individuals require lifelong 24/7 adult supervision, support and services to reach even a modicum of personal safety, health and quality of life.

These girls and women are highly susceptible to abuse, including sexual abuse, assault and rape. A 2021 analysis documented a 32.9% prevalence rate of sexual abuse in adults with intellectual disability, with prevalence increasing with severity of the ID. Though seldom discussed, it is no secret that vulnerable intellectually disabled girls and women will involuntarily become pregnant.

In Dobbs, the Court established a “rational basis” test for abortion laws, saying a state law must be sustained “if there is a rational basis on which the legislature could have thought that it would serve legitimate state interests.” We write this letter to make it clear that there can be no rational basis for a state to deny access to abortions for girls and women disabled by autism and intellectual disability who are victimized by rape and involuntarily pregnant. Indeed, such a ban would be so barbaric as to shock the conscience.

Many of these autistic/ID females are so profoundly impaired they require lifelong, intensive support and care to accomplish the most basic activities of daily living. They would not understand the changes to their bodies, and typically would not even understand the concept of pregnancy or prenatal care. In labor they would not comprehend the pain of contractions or have the ability to follow even the simplest of instructions, like “push.” Forcing the girls and women to give birth would be overwhelmingly dangerous and traumatic. The alternative of a C-section is equally problematic, as it is a serious, highly invasive surgery involving complex anesthesia and that requires adherence to post-operative care the girl or woman would be unable to follow.

In addition, they also may have medical, genetic, or psychiatric comorbidities that sharply increase risks to themselves and the fetus. Studies have documented the increased risk of serious pregnancy and birth complications for women with intellectual disability, including preterm labor, low birth weight, low Apgar scores, pre-eclampsia, post-partum hemorrhage, C-section, perinatal mortality and stillbirth. 

In addition, many of these patients with significant ID require various medications, such as anticonvulsants and antipsychotics, that raise the risk for fetal abnormality, including birth defects, autism and intellectual disability. Combined with a genetic predisposition to mental disorder, these fetuses would be in tremendous peril. 

Then there is the question of care and support services following a birth. It goes without saying that these girls and women typically have no capacity to care for a child. Indeed, our country’s burgeoning population of people disabled by autism often lack access to Medicaid and other necessary services to fulfill their own care needs. Who will care for these mothers and children?

An abortion law that lacks attention to the dire realities we have enumerated must lack a any rational basis. No just or humane society would force a severely cognitively disabled woman, a traumatized rape survivor, to carry an involuntary pregnancy and give birth, while forcing a fetus to be subjected to compromised prenatal care and neurotoxic drugs, all without any plan for long-term care that the mother could not possibly provide.

The Dobbs court did not set forth the parameters for applying the rational basis test, but plainly, ignoring the dimension of risk in cases of maternal autism and developmental disability would be highly irrational. Indeed, the Mississippi statute at issue in the case allowed for post 15-week abortions in the case of medical emergency or severe fetal abnormality.

Should you have any questions or concerns about abortion access for girls and women in your state who are disabled by autism and related disorders, please do not hesitate to contact us at info@ncsautism.org.

Signed,

Board of Directors
National Council on Severe Autism