With Florida Governor Ron DeSantis signing a heartbeat bill into law Thursday, the debate over whether such bills are based on hard science, or are instead an emotional flash point, has taken on new resonance.
The Associated Press recently reported that for the progenitors of setting an abortion limit at six weeks, “hearts were easy to market.” NBC News quoted medical professionals saying that the ultrasound at six weeks detects electrical impulses, or “cardiac activity,” not the visceral image we have of a live, beating heart. NPR took the same tack, quoting pro-choice experts arguing that both terms in the phrase “fetal heartbeat” are misleading, that the preborn baby is in fact an embryo, and that the heartbeat is not yet a heartbeat in a structure not yet a heart.
To probe whether the science supports this framing of heartbeat bills, National Review spoke to Dr. Christina Francis, a board-certified OB-GYN in Fort Wayne, Ind., and CEO of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG), which consists of nearly 7,000 medical professionals.
Francis explained that the goal for states such as Florida that are pursuing abortion regulation is to protect as many human beings as possible, whether preborn or born. The six-week abortion limit is not arbitrary, as heartbeats become detectable at that point with certain ultrasound technology. Thus, the limit is an evidentiary standard by which medical professionals can scientifically prove that a preborn child is in fact alive and viable. While Francis welcomes any restriction on abortion as a good thing, since “the science is exceedingly clear that a new distinct living human being comes into existence at the moment of fertilization,” she recognized it would be very difficult to limit abortion prior to the six-week mark, given the technology.
“The heart is contracting and pumping blood and this is what we actually see in ultrasounds early in pregnancy. It’s one of the markers that the preborn child is doing well. . . . You can actually see the blood coming into the heart, the heart contracting and pumping the blood out even as early as six weeks,” explained Francis.
“A heartbeat is not what defines whether or not an organism is living, but is certainly one of the first visible signs that we have when we’re taking care of pregnant women. We’ve got a living embryo growing inside of mom. We know from the very beginning — from the moment of fertilization — the heart starts to develop. It starts out as a tube-shaped organ, but it’s made up of the exact tissue and cells that will make up the heart when it’s fully formed,” Francis said.
Critics of such bills have pointed to the fact that the heart at the six-week mark lacks the structure it will ultimately develop. The valves are not there, for example. They also assert that the heartbeat is not a heartbeat per se, but merely an electrical precursor.
Francis waves away such arguments as nothing more than semantic games.
“What defines a heart is not its form but its function, which is to pump blood to the rest of the body, and that’s what that heart is doing from very early on even at about 3 weeks post-fertilization, when you’re already getting a heartbeat. . . . It’s made out of cardiac tissue and it’s serving the same purpose that it serves in you and I . . . which again is to circulate blood to the rest of the body,” Francis said, adding that some children can be born with heart abnormalities such as with a valve that’s not even fully formed.
Francis also explained that the electrical-impulse argument is a red herring. “What do they call the rhythmic contraction of the heart between six and ten weeks? It’s nothing except for a heartbeat. And I guarantee when they have a patient in the office and they’re doing an ultrasound with them they don’t say ‘There’s your baby’s electrical impulse.’ They say, ‘There’s your baby’s heartbeat,'” explained Francis. “You and I have electric impulses that go through our heart every single day, too. . . . Electrical impulses are going through the cardiac cells that make up the muscle of the heart and causing them to contract, which is why people get irregular heartbeats when they have an aberrant electrical pathway in their heart.”
“It’s really a false separation to try to separate an electrical impulse and a heartbeat, because the heartbeat is caused by the electrical impulse,” Francis asserted.
The AAPLOG CEO also sought to collapse the distinction between an embryo and a fetus. “We know by the law of biogenesis that two human beings can only create another human being, so an embryo doesn’t mean that that’s not a human being,” said Francis. “We change from embryonic human beings to fetal human beings at the eight-week mark. That’s simply a stage of development. We go on after we’re born to become neonates, infants, toddlers, children, adolescents, teenagers, adults — this is a spectrum of development.”
“Do we believe in true human equality? Then we can’t discriminate against one human being simply because they’re at a different stage of development,” Francis added.
The technology that’s available to detect a heartbeat and monitor the unborn child is a crucial part of this conversation. The ultrasound which is used to detect a heartbeat at the six-week mark is a transvaginal ultrasound, which is done closer to where the preborn baby is and allows the medical professional to see the preborn baby in more detail. Transabdominal ultrasounds detect a heartbeat a few weeks later. Exactly when the heartbeat becomes detectable transabdominally depends upon the woman’s weight and anatomy.
National Review asked Francis what she thinks will happen if ultrasound technology advances further, allowing medical professionals to determine sooner that a preborn baby is alive and viable. Francis replied that she could see states setting abortion limits prior to the six-week mark.
Asked about other evidentiary standards that could be used to determine life and viability, the AAPLOG CEO explained that the heartbeat will likely remain the gold standard. “Yes, you can look at fetal brain activity in pregnancy with very complicated technology that most physicians’s offices are not going to have [but] a heartbeat is detectable with common technology that pretty much any physician’s office and hospital has if they’re caring for pregnant women,” Francis explained, adding that a heartbeat is easy to look for and an ultrasound is noninvasive.
Francis then weighed in on a separate issue brought up by those opposed to stricter abortion regulations — reports that women are being denied care in life-threatening situations. Examples of situations in which a woman might need care include a miscarriage or an ectopic pregnancy in which the embryo has implanted somewhere other than the uterus, such as the fallopian tubes.
Francis asserted that neither Florida’s law nor any other abortion restriction throughout the country prevents miscarriage treatment or life-saving treatment. She explained that, if they are not already, physicians and hospital systems need to be educated on this, and states must make very clear that physicians can and should intervene in such cases. Francis said that she works as an OB hospitalist and that she deals with high-risk pregnancies in addition to normal pregnancies. “If we don’t intervene, you lose two lives. If we can intervene to save at least one of them, that’s absolutely what we have to do,” Francis said, regarding ectopic pregnancies. “I have never, as a pro-life physician, hesitated in the slightest to intervene in those situations, because I’m pro-life for all of my patients. Pro-life for mom and pro-life for baby.”
Francis said that the intent in those situations is not to end the life of the preborn baby but to preserve the life of the mother, which Francis views as different from the intent behind elective abortions, which to her is one thing and one thing only: to end the life of that embryonic or fetal human being. “The confusion that is reported to be out there comes not from the law, but from a misunderstanding of the law,” Francis said.
The AAPLOG CEO also addressed the fact that, according to the law in Florida, psychological conditions do not exempt an individual from the abortion limit. In addition to the life or health of the mother, S.B. 300 makes exceptions only in the case of rape, incest, or human trafficking. “Treating mental illness by ending the life of a human being is not evidence-based,” explained Francis. “We know that with women with preexisting mental-health disorders, their risk of suicide increases by six to seven times if they have an abortion versus carrying a pregnancy to term, even when it’s an unexpected or undesired pregnancy.”
“We have a mental-health epidemic. Fifty years of essentially unfettered access to abortion under the ruling of Roe, before Roe was overturned, did nothing to improve mental health. In fact, it actively worsened during that 50 years,” Francis added.
She said that her organization’s membership is expanding. AAPLOG has been increasingly able to offer an alternative to the American College of Obstetricians and Gynecologists, which in Francis’s view has become radically pro-abortion. That organization frequently does not take into account the stances of many of its members, Francis argued, pointing to recent studies that only a single-digit percentage of OB-GYNs throughout the country perform elective abortions.
“It’s time to take a different tack and to really affirm the lives of both of our patients,” Francis concluded.