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Clinicians and providers must prepare for impending abortion access crisis

The recently leaked ruling from the Supreme Court in Dobbs v. Jackson Women’s Health Organization indicates that Roe v. Wade soon will no longer be the law of the land. ANSIRH’s Daniel Grossman, MD, with co-authors Jamila Perritt, MD, PH, and Deborah Grady, MD, MPH, urge physicians and clinicians to prepare for this dramatic policy shift, in a new editorial for JAMA Internal Medicine.

Abortion access will be determined by state laws if the Supreme Court moves to overturn Roe v. Wade. It is likely that about half of states will ban abortion, putting essential, reproductive healthcare out of reach for millions of Americans. ANSIRH Director Daniel Grossman, MD, and his colleagues predict an increase in people seeking abortion in other states and self-managing their abortion; those unable to access abortion care will be forced to carry their pregnancy to term.

In this editorial, the authors argue that this seismic shift in abortion access will have far-reaching effects that providers and clinicians must consider in their practice. First, the researchers point out that, provided people have information about how to use medication abortion correctly, the medical risks of self-managed abortion are likely to be minimal. The legal risks, however, will be more substantial, with the possibility that people who merely experience pregnancy loss may face criminal charges.

The authors also highlight estimates indicating that maternal mortality will increase as abortion bans go into effect. Research from the Turnaway Study shows continuing an unwanted pregnancy is associated with an increased risk of subsequently living in poverty, a higher likelihood of being tethered to an abusive partner, and negative effects on child development.

Undoubtedly, eliminating abortion access in about half of states will push many people to seek care out of state, and the authors surmise that this will create more logistical burdens and an influx of patients in states where abortion remains legal. For many patients, the journey out of state will be impossible.

With these consequences in mind, the authors propose that providers and clinicians consider the following in the wake of the Supreme Court’s decision. For those practicing in states with bans:

  • It will be essential to know what organizations provide information and logistical support to people seeking care out of state
  • They should become informed and be prepared to respond to questions from patients regarding self-managed abortion, adopting a harm-reduction approach
  • For healthcare teams practicing in emergency, urgent, or primary care settings, they should be prepared to care for serious complications, but also answer questions about whether the abortion is complete or assess whether mild symptoms such as pain or minor bleeding require treatment.
  • Clinicians will need to familiarize themselves with the normal course of medication abortion to avoid unnecessary medical or surgical intervention and increased risk to the patient.
  • Clinicians should actively work to minimize the possibility of criminal charges against patients and not participate in any such efforts.

For those practicing in states where abortion will remain legal:

  • They should work with advocates and policymakers to reduce barriers to safe abortion care in their state.
  • They should advocate for proactive policies to expand care and increase funding for patients seeking care.
  • They will have increased responsibilities to provide training in abortion care to clinicians in states with bans.

As the authors write,

“After almost 50 years of legalized abortion in the US, most clinicians who provide reproductive health care find it difficult to fathom the far-reaching effects that state bans on the procedure will have. It is abundantly clear, however, that the health and socioeconomic wellbeing of people with the capacity for pregnancy will suffer. Clinicians will bear witness to this suffering and should be vocal advocates against harmful state laws.”

Read the full editorial, The Impending Crisis of Access to Safe Abortion Care in the US, in JAMA Internal Medicine.