At a town hall in Iowa last weekend, a police officer asked Hillary Clinton about women who survive the Islamic State’s brutality in war-torn Syria and Iraq. If they become pregnant from rape, should American aid help cover a safe abortion?

The question highlighted the growing debate around a 42-year-old law that stops U.S. foreign aid from funding the procedure "as a method of family planning."

Antiabortion groups hailed the 1973 Helms amendment as a victory in the aftermath of Roe v. Wade. But Democrats in Washington say the law has been applied too broadly, blocking victims of sexual assault in conflict zones from urgent medical care.

Abortion after rape, they argue, is not "a method of family planning."

Relaxing the Helm amendment would require a presidential memorandum — a move President Obama has avoided, despite publicly condemning assaults on women in areas of unrest. Clinton took a similar approach in the town hall meeting, arguing the United States should find some way to provide medical care to victims. She did not, however, commit to taking action on the Helms amendment.

Rape is no new tool of war, but the Islamic State has pushed it back into the international spotlight. A pamphlet released by the terrorist group says the sexual assault of captive women is permitted:

“Allah the almighty said: “[Successful are the believers] who guard their chastity, except from their wives or (the captives and slaves) that their right hands possess, for then they are free from blame.”

It's hard to quantify the prevalence of such crimes in Syria and Iraq. Data isn't collected in active war zones, and victims often don't speak up. The Women’s Media Center offers one window into the tragedy, tracking news reports of sexual violence in the Middle East. So far, they’ve collected 275 accounts, though the number is probably much higher.

The United Nations has warned for years that abuse of women spikes during war. Though there are other hurdles beyond the Helms amendment to accessing safe abortions for victims of the Islamic State — including local antiabortion laws — women’s stories have fueled a push to knock down foreign aid restrictions on Capitol Hill.

Last month, 28 Democratic senators signed a letter pressing Obama to change the official interpretation of the law. A petition is nearing its goal of 10,000 signatures. And a national poll commissioned last year by the Center for Health and Gender Equity, an advocacy group focused on reproductive rights, found 57 percent of respondents supported the use of foreign aid for abortion in cases of rape, while 21 percent disagreed with the measure.

“There’s such a heightened awareness, and there's been a dramatic shift in attitude about abortion since 1973," said Serra Sippel, president of the group

Rules abroad don't match laws at home, Sippel noted. Pregnant women who endured rape on domestic soil may use federal dollars to cover abortions. But aid workers in conflict zones must turn away victims who request the same help.

According to Human Rights Watch, a 20-year-old named Dilara described near-constant abuse:

From 9:30 in the morning, men would come to buy girls to rape them. I saw in front of my eyes ISIS soldiers pulling hair, beating girls, and slamming the heads of anyone who resisted. They were like animals. … Once they took the girls out, they would rape them and bring them back to exchange for new girls.

There's a major need for emergency care, said Brian Atwood, former head of the U.S. Agency for International Development, which deploys aid workers to conflict zones across the world.

“A woman comes to you, she’s been raped by a terrorist, and she doesn’t want to carry the child,” he said. “She will go out and get a risky abortion. She might die in the process.”

Roughly 47,000 women worldwide die from an unsafe abortion each year, estimates the Center for Health and Gender Equity estimate. Some sustain life-threatening injuries.

Atwood, now a public affairs professor at the University of Minnesota, said he's glad more people are paying attention to the aid law. It received little attention in past election cycles despite its prevalence in conflict zones.

During the Rwandan Genocide in 1994, the slaughter of the Tutsi minority group cost an estimated 800,000 lives. During the bloodshed, attackers raped roughly 250,000 women, according to a United Nations report.

After the 100-day battle ended, U.S. aid workers under Atwood’s leadership delivered food and medicine to displaced Rwandans. He said it’s unlikely that any Rwandan women lived through the violent sexual assaults inflicted during the mass slaughter, but the Helms amendment would have prevented USAID workers from helping any who did to access an abortion.

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