Twenty-eight weeks into my pregnancy, I developed a life-threatening illness, the only cure for which was to not be pregnant. Luckily, I was far enough along that I didn't need to have an abortion to save my life, but my daughter's birth was still mired in terror.



At 28 weeks, Layla was born via emergency c-section. I wasn't sure if I would make it – before my doctors made the first cut, I told my husband that if I died he should tell my sister that Layla's middle name, Sorella, was for her.

Twenty-four hours later, when I finally saw my daughter, she was just two pounds – all skin and bones and transparent skin. It was horrible. She spent the next two months in the hospital and endured a tremendous amount of medical intervention – blood transfusions, treatment for a collapsed lung, intubation so she could breathe, tubes to feed her, wires to monitor everything.

Now, at four years old, Layla is healthy, happy and has grown out of any lasting preemie problems. She loves ballet, rabbits and singing every song on the Frozen soundtrack (over and over again). And I'm the happy mother of a baby born at 28 weeks. I'm also a person who has complicated feelings about later-term abortions – the issue feels more morally complex to me than it had before I met my daughter.

But I am also more pro-choice than before. I know first-hand what it's like to have a pregnancy threaten your life, and how quickly – and without warning – things can go wrong. The exceptions for abortion laws are so often rattled off – life, health, rape, incest – that we forget what they really mean. The cut-off dates are so arbitrary – six weeks (North Dakota), 12 weeks (Arkansas), 20 weeks (more and more states) – that it's easy to forget the lives and experiences behind those words and numbers.

Last week, Mississippi governor Phil Bryant signed a bill banning abortions after 20 weeks. The law will only allow for abortions in cases of possible death, permanent injury or severe fetal abnormalities. What does that look like in real life? What constitutes "severe"? At what point does a woman's illness threaten her life?

Dr Dan Grossman, vice president for research at Ibis Reproductive Health and assistant clinical professor in obstetrics, gynecology and reproductive sciences at UCSF, says exceptions like these could impair doctors' ability to care for patients.* "Medicine isn't always so clear-cut, and an individual woman's situation could make a given condition more severe than it might be for another," he tells me. "But in the context of a hostile legal environment, doctors may be wary to go out on a limb and insist that a woman's condition merits a legal abortion."

Grossman says the process of determining whether the severity of a condition warrants an abortion could take so long that a patient's condition worsens. Indeed, any of the diseases that strike pregnant women – like pre-eclampsia, which I had – are not dangerous right away. They start off as warning signs for worse things to come.

In Ireland, abortions are legal when a woman's life is in danger, but that didn't stop the negligent death of Savita Halappanavar, a woman who was denied an abortion for her already-doomed pregnancy, then died a painful death as a result.

From Mississippi to North Carolina, to soon maybe South Carolina and Florida and West Virginia and more, the 20-week ban is a rallying cry for anti-choicers who believe later abortions make Americans uncomfortable. And they're not necessarily wrong: the 20-week legislation is not as extreme as anti-choice "heartbeat bills", which would ban abortions so early some women wouldn't even know they were pregnant yet. And US public support for abortion rights does drop the later a pregnancy develops.

But what anti-choicers don't understand – and almost never reflect in their policy or prose – is that pregnancy, abortion and birth are too complicated for assigning strict moral designations, let alone to legislate. Whenever the actual circumstances of why women seek abortions after 20 weeks get included in polling questions, most Americans strongly oppose later-term abortion bans. Because at heart, we know: this is complicated.

Parents facing pregnancies with a fetus too sick to live, parents who must make awful decisions about the quality of life they would want for their child – these parents should not have to jump through legal hoops. Women who are sick should not have to prove that they are "ill enough". Only 1.5% of women who have abortions even have them after 20 weeks, and whatever the reasons they need those abortions, their choices are far too nuanced and personal for us to ever believe we could create a policy around them. These are decisions for families to make, not politicians.

Because don't forget: part of the reason women seek later abortions is because anti-choice laws and policies make birth control and early abortion that much more difficult to access. There's abstinence-only education. There are consent laws and waiting periods and the fact that most counties in the US don't even have an abortion provider – Mississippi, depending on how a federal appeals court rules on a case it heard this week, soon may not have any in the entire state.

The anti-choice activists behind these policies find pro-choice mothers like me baffling. We disrupt their narrative of "good" women who have babies and "bad" women who have abortions. They can't wrap their heads around the idea that women have both abortions and babies – and that one of the top reasons women give for getting an abortion is out of concern for their existing children.

It's not often that I look back on photos of Layla while she was in the NICU – it's too painful. But when I do, she doesn't look like a baby. She looks, well, like a fetus. Of course, my husband and I never called her that – from the moment the stick read PREGNANT, until 28 weeks later, when she came out, tiny and fragile, we called her our "baby". This, too, is not inconsistent with being pro-choice.

But nothing is truly consistent about being pregnant or having a baby. Nothing is simple, nothing is clear-cut. And it doesn't have to be.

* Disclosure: Grossman serves with me on the Board of Directors of NARAL Pro-Choice America.