We Cannot Rest Until Abortion Rights Are Restored

On May 3, 2022, Morgan S. Levy, Shira Fishbach, Vineet Arora, MD, MAPP, and Arghavan Salles, MD, PhD shared their perspective on the need for broader access to abortion training in the wake of Roe v. Wade being overturned. As part of MedPage Today‘s review of the past year’s top events, the authors follow up with their perspective on healthcare initiatives to protect abortion access since the Dobbs decision, and the importance of greater advocacy efforts in 2023.

The Supreme Court ruled to overturn Roe v. Wade with the Dobbs decision 6 months ago, thereby revoking the constitutional right to abortion. This decision affects physicians in virtually every specialty, and also directly affects many physicians and their families in their personal lives. Thus, it is critical for physicians in all fields to advocate for abortion rights. In the wake of the Dobbs decision, we have stood alongside many vocal physicians condemning government interference in the physician-patient relationship and specifically affirming the importance of access to abortion. Going into the New Year, healthcare professionals need to maintain and expand this momentum.

The Response to the Dobbs Decision

Unfortunately, not everyone in medicine has spoken up. Medical societies are powerful collectives of voices that amplify and advocate for key issues impacting the health of their patients and profession. Medical societies often leverage their power to advocate for policies to improve the health and welfare of patients, for example, related to firearms and vaccines.

However, in a recent study, we found that the majority of 187 major medical specialty societies were silent on abortion rights. In the 2 weeks following the leaked draft opinion, when statements may have had maximal impact, fewer than 1 in 10 (9.1%) medical societies published a statement affirming their commitment to abortion access. Medical societies were more than four times (38.5%) more likely to make a statement in the 2 weeks after the official SCOTUS decision. Even so, some of these statements did not even use the word “abortion,” instead articulating a commitment to “reproductive rights,” a fairly vague phrase.

While all 10 ob/gyn societies we studied made a formal statement, many physicians in other specialties also raised awareness of how the Dobbs decision impedes their practice and harms their patients. Rheumatologists, for example, who routinely prescribe methotrexate (a high-risk medication in pregnancy) have patients who have been unable to fill their prescriptions due to changes in abortion access. Oncologists, who see patients facing new diagnoses of cancer during pregnancy, as occurs in 1 in 1,000 cancer patients, are now stuck figuring out how to navigate new abortion laws or else delay life-saving treatment. In fact, ensuring pregnant patients receive the standard of care is now at risk more broadly, all due to the lack of abortion access. In November 2022, JAMA dedicated a special issue to Health Care Access and Reproductive Rights, a signal of how important abortion access is for patient care and the physician workforce.

The public is speaking up too. In the last 6 months, whenever abortion rights have been on the ballot — in states such as Kentucky, Michigan, Vermont, Montana, California, and Kansas — voters have chosen to preserve the right to abortion or prevent limits on abortion. In the midterm elections, many Democratic candidates whose platforms focused on protecting abortion rights also won their races, such as Gov. Joshua Shapiro (D-Pa.) who garnered support from physician advocates. These results are not surprising, given that the right to abortion is supported by over half of Americans.

Why Healthcare Professionals Should Care

We have already seen the early effects of abortion bans on patient care in all fields. Following the September 2021 decision on SB8 in Texas, which banned most abortions at or around 6 weeks of pregnancy, significantly more patients traveled out of state to access abortion care. Travel time to abortion facilities is now almost four times longer following the Dobbs decision, from 27.8 minutes on average prior to the decision compared to 100.4 minutes following the decision. Hindering abortion access harms pregnant people through a myriad of ways: it delays life-saving cancer care, increases risky pregnancy and abortion complications in the emergency department, limits the choices of parents pregnant with babies who will be born with life-altering or life-threatening anomalies, and harms the mental health and wellbeing of those with unwanted pregnancies.

Access to abortion care is just one of many considerations for medical trainees — regardless of whether they will provide abortion care or not. Medical students and residents are at risk of not being trained in the full spectrum of reproductive healthcare, including routine procedures such as dilation and curettage, treatment of ectopic pregnancies, and informed, unbiased counseling for patients considering pregnancy termination. Abortion bans affect students and residents in fields beyond just ob/gyn due to spillover effects into fields like emergency medicine or pediatrics. Additionally, trainees in any specialty can be impacted by the desire to preserve access to abortion care for their patients, their families, and themselves.

Because attacks on abortion rights are not expected to end, physicians in all fields must continue to advocate for abortion rights nationwide. This should be a priority for every health professional in 2023.

As physicians, we have the privilege of bearing witness to the critical role of preserving access to the full spectrum of reproductive healthcare. Access to care is essential not only for our patients, but also for the physician workforce, as our data shows over 1 in 10 physicians have had an abortion. For the patient whose amniotic sac ruptures at 22 weeks’ gestation and faces likely sepsis, or the patient with a new diagnosis of pulmonary hypertension for whom a pregnancy would be lethal, or for the pre-med student with aspirations to go to medical school: abortion is essential. We cannot rest until abortion rights are restored.

Morgan S. Levy is a medical student in the MD and Master’s in Public Health program at the University of Miami Miller School of Medicine. Shira Fishbach is an Obstetrics and Gynecology resident at the University of Michigan. Vineet Arora, MD, MAPP, is the Herbert T. Abelson professor of medicine and dean of medical education at the Pritzker School of Medicine at the University of Chicago. Arghavan Salles, MD, PhD, is a senior research scholar at the Clayman Institute for Gender Research and the special advisor for Diversity, Equity, and Inclusion Programs at Stanford University Department of Medicine.