Having an impact: How you can help your patients in the wake of Roe v Wade overruling

Natasha Schimmoeller, MD, MPH, MA, is an assistant professor in the Division of Family Planning within the Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center in Los Angeles, California.

Bryna J. Harwood, MD, is director of Gynecologic Specialties and the Obstetrics and Gynecology Residency Program at Cedars-Sinai Medical Center in Los Angeles, California.

Editor’s Note: This month’s editorial was written by a guest editor.

Abortion restrictions affect all of us. One in 4 women in the United States choose to end a pregnancy by age 45.¹ Statistically speaking, everyone knows someone who has had an abortion.² These women are not only our patients, but our mothers, sisters, friends, colleagues— even ourselves. As a family planning subspecialist, I see my future self in nearly every one of my patients.

Whether I’m rushing to the hospital in the middle of the night to perform a life-saving dilation and evacuation for a woman in septic shock or providing a routine medication abortion to a patient with contraceptive failure, I think about the women in states like Texas who are experiencing the same complications but lack access to basic, evidence-based reproductive care. I think about the families who have already lost or will lose loved ones because of the legislative restriction of abortion. I think about the physicians, trainees, nurses, and staff who are forced to act against the ethical tenets of the medical profession and deny the human responsibility to be compassionate but instead must watch patients die or suffer life-altering morbidity.

We must face reality. For decades, the doctor-patient relationship and the basic human right of reproductive autonomy have been subjected to a methodical attack. We know what will happen if the Supreme Court overturns long-standing legal precedent and gives states unchecked power to restrict abortion. Twenty-six states are certain or likely to ban abortion altogether.³ Excluding unsafe abortion, forced pregnancy alone will lead over time to an estimated 21% increase in maternal mortality, with a 33% increase for Black women.⁴ The Turnaway Study demonstrated the harm inflicted on women and all their children when they are denied abortions, including years of economic hardship and insecurity.^5-8 The women in my life—patients, friends, family, coworkers—are telling me they are scared, and their apprehension is justified.

As physicians, we have power. Here are some things you can do:

• If you are in a permissive state, integrate abortion into your practice. Eighty percent of abortions occur at or below 10 weeks’ gestation. Just providing medication abortion is helpful.¹
• If you are in a restricted state, have a referral plan.
• Use resources like ACOG’s Spontaneous and Induced Abortion Resource Center, which can answer clinical questions and help with reimbursement and with starting new services.⁹
• Teach trainees and preserve our workforce.
• Make time to vote and remind patients to do the same.¹⁰
• Streamline care in your institution, connect with other doctors, or just say the word abortion to reduce its stigma

References

1. Induced abortion in the United States. Guttmacher Institute. September 2019. Accessed June 2, 2022. https://www.guttmacher.org/fact-sheet/induced-abortion-united-states

2. National Network of Abortion Funds. Accessed June 2, 2022. https://abortionfunds.org/

3. Nash E, Cross L, Dreweke J. Roe v. Wade in peril: our latest resources. Guttmacher Institute. 2022. Accessed June 2, 2022. https://www.guttmacher.org/abortion-rights-supreme-court

4. Stevenson AJ. The pregnancy-related mortality impact of a total abortion ban in the United States: a research note on increased deaths due to remaining pregnant. Demography. 2021;58(6): 2019-2028. doi:10.1215/00703370-9585908

5. Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic outcomes of women who receive and women who are denied wanted abortions in the United States. Am J Public Health. 2018;108(3):407-413. doi:10.2105/AJPH.2017.304247

6. Miller S, Wherry LR, Foster DG. The economic consequences of being denied an abortion. The National Bureau of Economic Research Working Paper No. 26662. January 2020. Accessed June 2, 2022. doi:10.3386/w26662

7. Foster DG, Raifman SE, Gipson JD, Rocca CH, Biggs MA. Effects of carrying an unwanted pregnancy to term on women’s existing children. J Pediatr. 2019;205:183-189.e1. doi:10.1016/j.jpeds.2018.09.026

8. Foster DG, Biggs MA, Raifman S, Gipson J, Kimport K, Rocca CH. Comparison of health, development, maternal bonding, and poverty among children born after denial of abortion vs after pregnancies subsequent to an abortion. JAMA Pediatr. 2018;172(11):1053-1060. doi:10.1001/jamapediatrics.2018.1785

9. Implementing progress in abortion care and training (IMPACT). ACOG. Accessed June 2, 2022. https://www.acog.org/programs/impact

10. About us. Vot-ER. March 28, 2022. Accessed June 2, 2022. https://vot-er.org/aboutus/