The brain-dead American woman being forced to have her baby – and why the UK must stay vigilant

We're just human incubators to them,' say the headlines. The reality behind them is more harrowing still. Adriana Smith's story has, for the last few weeks, prompted uniform outrage around the world – a 30-year-old nurse from Georgia, brain-dead, kept alive only by machines against her family's wishes. Adriana should have been laid to rest months ago: the blood clots on her brain, found when she was admitted to hospital with severe pain in February, mean that, legally, she is no longer living. Except, she was nine weeks pregnant.
For more than 90 days, Adriana's body has been kept artificially alive, officially no longer her own, to prioritise the weeks-old pregnancy. Despite the protests of her grieving family – including her mother and her seven-year-old son – medics at the Emory University Hospital say there is no choice.
The state of Georgia is answerable: its six-week abortion ban, known as the heartbeat law, which prohibits the termination of a pregnancy once a heartbeat has been detected, constitutes 'foetal personhood' and declares the foetus an individual patient. The 'personhood' of a woman like Adriana, then, is denied.
There is no denying how monstrous the situation is – and how unbelievable it should be. In 2019, the very year that Georgia's heartbeat bill was passed, a like-for-like depiction of Adriana's story provided a stark warning in series three of the TV adaptation of Margaret Atwood's The Handmaid's Tale. Back then, it was the shocking, but dystopian – imagined – consequence of the end of bodily autonomy; little more than five years later, it's a reality that has not only sparked furious indignation, but further highlighted the maternal mortality crisis continuing to affect Black women.
The foetus in Adriana's body is now 23 weeks – over halfway to full gestation – and she will remain in this position, between life and death, for at least another 10 weeks. According to reports, doctors have seen fluid in the foetus's brain; it's not clear whether it will survive.
'My grandson may be blind, may not be able to walk, we don't know if he'll live once she has him,' April Newkirk, Adriana's mother, told the Atlanta TV channel WXIA. The family are already now facing an untold financial burden on top of the sudden loss of Adriana. 'And I'm not saying we would have chosen to terminate her pregnancy. What I'm saying is we should have had a choice.'
In the US, not much has been heard from anti- abortion groups who lobbied for these laws in response to the family going public. In fact, most have been curiously quiet despite their seeds having been sown. The writer and activist Jessica Valenti called them cowards – 'it's that simple', she wrote last week. But in that silence a precedent could be set. Adriana might be the first woman we know of publicly to have been subjected to something so cruel, but it's unlikely she'll be the last.
'This is the effect of abortion bans – this is what happens when women are treated like incubators, whether they are alive or dead,' Rachael Clarke, head of advocacy at the British Pregnancy Advisory Service (BPAS), says. 'The only purpose of women in these states, essentially, is to bear children that many of them do not want or cannot care for. We've seen the impact that bans have on women's lives; we've seen the impact on their health and their children's health. It's nothing but vindictive.'
Around the world, the statistics speak for themselves. Where abortion rights are granted, rates drop, as do the number of maternal deaths – in Nepal, for example, the number of women dying due to pregnancy and childbirth dropped by 72 per cent after abortion was legalised. Generally, more reproductive rights lead to strong communities and even economies. The UK appears to be one of the most progressive countries when it comes to reproductive rights, yet abortion is still not entirely legal here. The 1967 Abortion Act, now 58 years old and decidedly unfit for purpose, allows terminations only under specific, limited circumstances. Anything outside of those carries a maximum sentence of life imprisonment.
Outside of those parameters (before 23 weeks and six days' gestation; being given permission to terminate by two doctors who must decide 'in good faith' that carrying on a pregnancy would cause a woman physical or mental harm), abortion is illegal. And right now, that law is increasingly putting British women at risk.
'What we've seen in the past couple of weeks is worrying,' Clarke says. A conversation has been bubbling after new guidance from the National Police Chiefs' Council, quietly published in January, came to light, informing UK police how to search a woman's phone and menstrual tracking apps, along with her home, following a 'suspicious' pregnancy loss. 'These kinds of things are really damaging and really quite terrifying to women who learn about them.
'The shocking thing is, actually, you look at some of the comments on social media, and people are saying that they don't understand why stories are on their feed – they think that it's about America. And you have to say, 'No, this is something that is happening in England and Wales'.'
In fact, even in America, a pregnant woman who ends her own pregnancy outside of the law can't be criminalised. Yet in the UK, prosecutions are actually increasing.
Despite there only having been a handful of known convictions in the 160 years since the Offences against the Person Act, which criminalises the act of inducing a termination – taking pills, for example – was first introduced in England and Wales, in just the last two years six women have been charged under the act and appeared in court, an unprecedented number. The question is, why?
Clarke says that there isn't one answer, but it could partly come down to a trend – that police officers and CPS lawyers are seeing more cases reported and are therefore more hyper-aware. 'And what we see then is quite a lot of overzealous interest in some women, including some women who have not taken any medication, who have not had any role in a premature birth or a stillbirth, but because police have seen it on the news and in reporting, or in the guidance that went out in the last few months, it makes them suspicious of women in a way that they may not have been 10 years ago. As a result, these women are paying the price.'
'The case of Adriana is very much one that law professors would theorise about – what would happen if we have foetal personhood? What would we do if a mother fell ill?' says Sam Yousef, chair of the board of trustees of Reproductive Justice Initiative. 'Now it's actually happened, we've seen the legislation has [had a] chilling effect on medical practitioners who are so worried about the law that they can't do right for the patient, or what's right for the family.
'And I think that's also what we're seeing in the UK in terms of people feeling that they have to report people to the police in any way, shape or form if they're 'worried' about a miscarriage or abortion they've witnessed, or the circumstances surrounding it.'
It could also be part of the cultural misogyny seen accompanying political shifts to the right; abortion rights often go hand in hand with other liberal causes, many of which have recently been under threat, adds Yousef. 'At the core of this is bodily autonomy,' he says. 'There's the increased policing and reporting, but something also seems to have changed within the Crown Prosecution Service and the police, where they seem to be more willing and wanting to take up these cases.
This is the effect of abortion bans – this is what happens when women are treated like incubators, whether they are alive or dead
Rachael Clarke, head of advocacy at the British Pregnancy Advisory Service
'That probably has to do with the narratives that are being pushed around abortion. We know that there's more money being funnelled into the UK for anti-abortion activist groups from the US. We don't know loads about them but we do know that, in some cases, in the largest anti-abortion lobbying groups from the US, these are the groups that are also campaigning against things like trans rights.'
Clarke adds that the cases we see in public – that of Bethany Cox, for example, a 22-year-old from Eaglescliffe in Stockton who was found not guilty of child destruction and using misoprostol to procure her own miscarriage in 2020 – are not the full picture.
'It's been six women in court in the last couple of years, but as a sector we've probably had about 100 requests from the police for medical records of women they're suspicious of and they're investigating,' she explains. 'So these women who are appearing in court and the one woman who spent time in prison are really just the tip of the iceberg. Underneath there are huge numbers of women who are being caught up by the police, who might end up being arrested, released on bail, who might have bail conditions put in around not being allowed access to children or their own children – even social services get pulled into it.'
Most of the women never make it to court because there isn't enough evidence or it's 'not in the public interest', 'but it doesn't stop the police searching their houses, seizing their phones, keeping them from their kids'.
The damage lingers: despite our progress, a stigma still very much exists. And a law that hauls often desperate, vulnerable women into police cells from hospital beds and denies them medical care only does further harm.
BPAS have been campaigning to decriminalise abortion since 2012 – and still now the fight is not over. Currently, they are working with Tonia Antoniazzi, a Welsh Labour MP who has an amendment to the Crime and Policing Bill which would remove women from the criminal abortion law.
It's supported by 50 organisations – including five medical Royal Colleges, violence against women and girls groups, trade unions, abortion providers and more than 90 MPs have signed up to it ahead of the vote to pass it in June (you can use their easy tool to write to your MP in support). 'It's time for abortion to be what it is, which is a healthcare procedure and a healthcare decision, and for full abortion rights and reproductive rights and justice to be finally fulfilled so that people can get the care that they need and they deserve,' says Yousef. It feels hopeful – but there are no guarantees.
Adriana's family must continue to endure the terrible fate constructed by laws intended to harm women like her. But her story doesn't exist in a vacuum – she is not an anomaly, far from it. During the last parliament there were several attempts to restrict access to abortion, including an amendment to cut the legal limit from 24 weeks to 22, vocally supported by Reform UK's leader, Nigel Farage. 'Extreme' anti-abortion protestors from the US have already moved into the UK, increasing their spending here and lobbying susceptible MPs. For the sake of women like Adriana, complacency isn't an option.

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