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Trump is an abnormal candidate. But his lies about abortion are very normal.

The abortion wars in America are a battle between fantasy and reality.

Final Presidential Debate Between Hillary Clinton And Donald Trump Held In Las Vegas Photo by Drew Angerer/Getty Images

Trump’s falsehoods about abortion at Wednesday night’s debate were no less wrong and dangerous than many of his other lies.

It’s not only false to suggest, as Trump did, that Hillary Clinton supports abortions “in the ninth month” of pregnancy — those kinds of abortions don’t even exist, as Vox’s Sarah Kliff explained. If a woman wants an abortion after a fetus is viable, no doctor will give her one unless there is something seriously wrong with either the fetus or her own health. And if a pregnancy has to be ended early in the ninth month, it will be an induced labor, not an abortion.

Pretending otherwise misrepresents reality, which is bad enough. It’s a common misrepresentation on the right and among Republicans; Marco Rubio and Rand Paul both used similar late-term abortion myths to attack Democrats earlier this year.

But myths like these do real harm to women who have to make heartbreaking medical decisions very late in pregnancy. They inspire legislation that makes an already hellish experience even worse.

When one woman needed an abortion at 32 weeks due to a serious fetal anomaly, she had to fly from New York to Colorado to get it — because even in blue-state New York, she could only get a legal abortion that late if her life was literally in danger.

Donald Trump’s constant lying and consistent ignorance on policy issues has lowered the bar for what we consider “normal” in American politics. But when it comes to abortion politics in America, the troubling thing is that Trump isn’t abnormal at all.

The real abortion wars in America aren’t about philosophy. They’re about how doctors get to practice medicine.

The modern pro-life agenda isn’t just about hoping to overturn Roe v. Wade someday. It’s about actively trying to regulate abortion out of existence at the state level, with laws like the ones in Texas that the Supreme Court recently overturned because they targeted abortion clinics for closure for no good medical reason.

But other laws don’t just target the clinics. They target the specific procedures that doctors perform — and they do it using language that is total gibberish from a medical perspective.

Trump clearly doesn’t know how abortion works, and he arguably doesn’t even know how childbirth works. If you “rip” a newborn from its mother’s womb “in the ninth month,” that’s called a C-section.

To be fair, most Americans don’t know many basic facts about abortion — that it’s an incredibly safe medical procedure, for instance, or that it doesn’t actually require surgical cutting.

But anti-abortion policy in America is almost uniformly written by people who, just like Trump, very, very obviously don’t understand the medical realities of pregnancy and childbirth.

Again and again, states pass anti-abortion laws that either require doctors to do something that makes no sense, or require them to perform a procedure that actually puts their patients at greater risk of harm:

  • A new law in Utah requires “fetal anesthesia” for later abortions. Except, depending on which doctor you ask, this anesthesia either doesn’t exist or would require a more-dangerous procedure that unnecessarily anesthetizes the woman. "It's like saying, 'Take someone's widget out using standard medical practice.' I don't know what that means,” Dr. Leah Torres, an OB-GYN and abortion provider in Utah, told Vox in March.
  • A bill signed by Gov. Mike Pence (Trump’s running mate) in Indiana would have required all fetal tissue at any stage of development, whether from an abortion or a miscarriage, to be cremated or buried. The problem, other than interfering with women’s decision-making and making abortion more expensive? It could technically apply to the blood and tissue a woman passes during her period, since she could be having a miscarriage then without knowing it.
  • A law in Ohio required doctors to use an outdated prescription regimen for medication abortion — and research found that it caused unnecessary physical harm to the women who were forced to take it. “Women got out to the parking lot, and they were vomiting and they had to come back [to the clinic] and take the dosage again,” Ushma Upadhyay, the lead author of the study, told Rewire.
  • The standard “rape, incest, or life endangerment” exception to many abortion bans doesn’t include an exception for a woman’s health — which excludes all kinds of serious medical conditions, as well as fetal anomalies. That means a doctor would have to let a sick patient get sicker and sicker, until her life is literally and irrefutably in danger, before being allowed to perform a medically necessary abortion. (This has been known to happen when women have miscarriages in Catholic hospitals that refuse to perform abortions.)
  • Many state-level “20-week” abortion bans bills use medically inaccurate language to describe the gestational age of the fetus. That causes confusion about whether the law targets women who are 20 weeks pregnant or 22 weeks — and doctors could face jail time if they get it wrong.

This list is far from exhaustive. Over and over, state and federal legislators write laws that literally force doctors to ignore their own best medical judgment — or that threaten doctors with jail if they don’t comply with a law that makes no medical sense.

Donald Trump talked about a fantasy. Hillary Clinton talked about reality.

These are the battle lines of the abortion wars in America. They’re not about thought experiments on ninth-month abortions, or philosophical differences over when life really begins. They’re about real women’s bodies, and real doctors practicing real medicine on those bodies.

That’s why Hillary Clinton’s response to Trump’s “ninth month” answer was so powerful. Her defense of abortion rights in Wednesday night’s debate was one of her strongest and most passionate moments of any debate, or even of the campaign.

It was personal and emotional. It was rooted in Clinton’s own lived experiences — as a woman who knows what it’s like to be pregnant and give birth, as a diplomat who has seen brutal repression of pregnant women abroad, and as a public servant who has spoken to the women who actually face those heavily-politicized “late-term abortions.”

“You should meet with some of the women that I've met with,” Clinton said to Trump. “I have met with women who, toward the end of their pregnancy, get the worst news one could get — that their health is in jeopardy if they continue to carry to term or that something terrible has happened or just been discovered about the pregnancy.”

She’s seen what it looks like, she said, when “governments forced women to have abortions like they did in China or force women to bear children like they used to do in Romania. I can tell you the government has no business in the decisions that women make with their families in accordance with their faith, with medical advice, and I will stand up for that right.”

Clinton spoke with the moral force of somebody who knows what it means, in flesh and blood and pain and suffering, to carry a pregnancy to term — and what it means when that isn’t possible.

Trump, by contrast, talked like somebody who doesn’t understand any of that at all. And he’s not alone.