Constance Bohon, MD

The 1973 Supreme Court of the United States (SCOTUS) decision in Roe v Wade was a landmark ruling,¹ establishing that the United States Constitution provides a fundamental “right to privacy,” protecting pregnant people’s freedom to access all available reproductive health care options. Recognizing that the right to abortion was not absolute, the majority of justices supported a trimester system. In the first trimester, decisions about abortion care are fully controlled by patients and clinicians, and no government could place restrictions on access to abortion. In the second trimester, SCOTUS ruled that states may choose to regulate abortion to protect maternal health. (As an example of such state restrictions, in Massachusetts, for many years, but no longer, the state required that abortions occur in a hospital when the patient was between 18 and 24 weeks’ gestation in order to facilitate comprehensive emergency care for complications.) Beginning in the third trimester, a point at which a fetus could be viable, the Court ruled that a government could prohibit abortion except when an abortion was necessary to protect the life or health of the pregnant person. In 1992, the SCOTUS decision in Planned Parenthood v Casey² rejected the trimester system, reaffirming the right to an abortion before fetal viability, and adopting a new standard that states may not create an undue burden on a person seeking an abortion before fetal viability. SCOTUS ruled that an undue burden exists if the purpose of a regulation is to place substantial obstacles in the path of a person seeking an abortion.

If, as anticipated, the 2022 SCOTUS decision in Dobbs v Jackson Women’s Health Organization³ overturns the precedents set in Roe v Wade and Planned Parenthood v Casey, decisions on abortion law will be relegated to elected legislators and state courts.⁴ It is expected that at least 26 state legislatures and governors will enact stringent new restrictions on access to abortion. This cataclysmic reversal of judicial opinion creates a historic challenge to obstetrician-gynecologists and their patients and could threaten access to other vital reproductive services beyond abortion, like contraception. We will be fighting, state by state, for people’s right to access all available reproductive health procedures. This will also significantly affect the ability for providers in women’s reproductive health to obtain appropriate and necessary education and training in a critical skills. If access to safe abortion is restricted, we fear patients may be forced to consider unsafe abortion, raising the specter of a return to the 1960s, when an epidemic of unsafe abortion caused countless injuries and deaths.^5,6

How do we best prepare for these challenges?

• We will need to be flexible and continually evolve our clinical practices to be adherent with state and local legislation and regulation.
• To reduce unintended pregnancies, we need to strengthen our efforts to ensure that every patient has ready access to all available contraceptive options with no out-of-pocket cost.
• When a contraceptive is desired, we will focus on educating people about effectiveness, and offering them highly reliable contraception, such as the implant or intrauterine devices.
• We need to ensure timely access to abortion if state-based laws permit abortion before 6 or 7 weeks’ gestation. Providing medication abortion without an in-person visit using a telehealth option would be one option to expand rapid access to early first trimester abortion.
• Clinicians in states with access to abortion services will need to collaborate with colleagues in states with restrictions on abortion services to improve patient access across state borders.

On a national level, advancing our effective advocacy in Congress may lead to national legislation passed and signed by the President. This could supersede most state laws prohibiting access to comprehensive women’s reproductive health and create a unified, national approach to abortion care, allowing for the appropriate training of all obstetrician-gynecologists. We will also need to develop teams in every state capable of advocating for laws that ensure access to all reproductive health care options. The American College of Obstetricians and Gynecologists has leaders trained and tasked with legislative advocacy in every state.⁷ This network will be a foundation upon which to build additional advocacy efforts.

As women’s health care professionals, our responsibility to our patients, is to work to ensure universal access to safe and effective comprehensive reproductive options, and to ensure that our workforce is prepared to meet the needs of our patients by defending the patient-clinician relationship. Abortion care saves lives of pregnant patients and reduces maternal morbidity.⁸ Access to safe abortion care as part of comprehensive reproductive services is an important component of health care. ●

The 1973 Supreme Court of the United States (SCOTUS) decision in Roe v Wade was a landmark ruling,¹ establishing that the United States Constitution provides a fundamental “right to privacy,” protecting pregnant people’s freedom to access all available reproductive health care options. Recognizing that the right to abortion was not absolute, the majority of justices supported a trimester system. In the first trimester, decisions about abortion care are fully controlled by patients and clinicians, and no government could place restrictions on access to abortion. In the second trimester, SCOTUS ruled that states may choose to regulate abortion to protect maternal health. (As an example of such state restrictions, in Massachusetts, for many years, but no longer, the state required that abortions occur in a hospital when the patient was between 18 and 24 weeks’ gestation in order to facilitate comprehensive emergency care for complications.) Beginning in the third trimester, a point at which a fetus could be viable, the Court ruled that a government could prohibit abortion except when an abortion was necessary to protect the life or health of the pregnant person. In 1992, the SCOTUS decision in Planned Parenthood v Casey² rejected the trimester system, reaffirming the right to an abortion before fetal viability, and adopting a new standard that states may not create an undue burden on a person seeking an abortion before fetal viability. SCOTUS ruled that an undue burden exists if the purpose of a regulation is to place substantial obstacles in the path of a person seeking an abortion.

If, as anticipated, the 2022 SCOTUS decision in Dobbs v Jackson Women’s Health Organization³ overturns the precedents set in Roe v Wade and Planned Parenthood v Casey, decisions on abortion law will be relegated to elected legislators and state courts.⁴ It is expected that at least 26 state legislatures and governors will enact stringent new restrictions on access to abortion. This cataclysmic reversal of judicial opinion creates a historic challenge to obstetrician-gynecologists and their patients and could threaten access to other vital reproductive services beyond abortion, like contraception. We will be fighting, state by state, for people’s right to access all available reproductive health procedures. This will also significantly affect the ability for providers in women’s reproductive health to obtain appropriate and necessary education and training in a critical skills. If access to safe abortion is restricted, we fear patients may be forced to consider unsafe abortion, raising the specter of a return to the 1960s, when an epidemic of unsafe abortion caused countless injuries and deaths.^5,6

How do we best prepare for these challenges?

• We will need to be flexible and continually evolve our clinical practices to be adherent with state and local legislation and regulation.
• To reduce unintended pregnancies, we need to strengthen our efforts to ensure that every patient has ready access to all available contraceptive options with no out-of-pocket cost.
• When a contraceptive is desired, we will focus on educating people about effectiveness, and offering them highly reliable contraception, such as the implant or intrauterine devices.
• We need to ensure timely access to abortion if state-based laws permit abortion before 6 or 7 weeks’ gestation. Providing medication abortion without an in-person visit using a telehealth option would be one option to expand rapid access to early first trimester abortion.
• Clinicians in states with access to abortion services will need to collaborate with colleagues in states with restrictions on abortion services to improve patient access across state borders.

On a national level, advancing our effective advocacy in Congress may lead to national legislation passed and signed by the President. This could supersede most state laws prohibiting access to comprehensive women’s reproductive health and create a unified, national approach to abortion care, allowing for the appropriate training of all obstetrician-gynecologists. We will also need to develop teams in every state capable of advocating for laws that ensure access to all reproductive health care options. The American College of Obstetricians and Gynecologists has leaders trained and tasked with legislative advocacy in every state.⁷ This network will be a foundation upon which to build additional advocacy efforts.

As women’s health care professionals, our responsibility to our patients, is to work to ensure universal access to safe and effective comprehensive reproductive options, and to ensure that our workforce is prepared to meet the needs of our patients by defending the patient-clinician relationship. Abortion care saves lives of pregnant patients and reduces maternal morbidity.⁸ Access to safe abortion care as part of comprehensive reproductive services is an important component of health care. ●

The 1973 Supreme Court of the United States (SCOTUS) decision in Roe v Wade was a landmark ruling,¹ establishing that the United States Constitution provides a fundamental “right to privacy,” protecting pregnant people’s freedom to access all available reproductive health care options. Recognizing that the right to abortion was not absolute, the majority of justices supported a trimester system. In the first trimester, decisions about abortion care are fully controlled by patients and clinicians, and no government could place restrictions on access to abortion. In the second trimester, SCOTUS ruled that states may choose to regulate abortion to protect maternal health. (As an example of such state restrictions, in Massachusetts, for many years, but no longer, the state required that abortions occur in a hospital when the patient was between 18 and 24 weeks’ gestation in order to facilitate comprehensive emergency care for complications.) Beginning in the third trimester, a point at which a fetus could be viable, the Court ruled that a government could prohibit abortion except when an abortion was necessary to protect the life or health of the pregnant person. In 1992, the SCOTUS decision in Planned Parenthood v Casey² rejected the trimester system, reaffirming the right to an abortion before fetal viability, and adopting a new standard that states may not create an undue burden on a person seeking an abortion before fetal viability. SCOTUS ruled that an undue burden exists if the purpose of a regulation is to place substantial obstacles in the path of a person seeking an abortion.

If, as anticipated, the 2022 SCOTUS decision in Dobbs v Jackson Women’s Health Organization³ overturns the precedents set in Roe v Wade and Planned Parenthood v Casey, decisions on abortion law will be relegated to elected legislators and state courts.⁴ It is expected that at least 26 state legislatures and governors will enact stringent new restrictions on access to abortion. This cataclysmic reversal of judicial opinion creates a historic challenge to obstetrician-gynecologists and their patients and could threaten access to other vital reproductive services beyond abortion, like contraception. We will be fighting, state by state, for people’s right to access all available reproductive health procedures. This will also significantly affect the ability for providers in women’s reproductive health to obtain appropriate and necessary education and training in a critical skills. If access to safe abortion is restricted, we fear patients may be forced to consider unsafe abortion, raising the specter of a return to the 1960s, when an epidemic of unsafe abortion caused countless injuries and deaths.^5,6

How do we best prepare for these challenges?

• We will need to be flexible and continually evolve our clinical practices to be adherent with state and local legislation and regulation.
• To reduce unintended pregnancies, we need to strengthen our efforts to ensure that every patient has ready access to all available contraceptive options with no out-of-pocket cost.
• When a contraceptive is desired, we will focus on educating people about effectiveness, and offering them highly reliable contraception, such as the implant or intrauterine devices.
• We need to ensure timely access to abortion if state-based laws permit abortion before 6 or 7 weeks’ gestation. Providing medication abortion without an in-person visit using a telehealth option would be one option to expand rapid access to early first trimester abortion.
• Clinicians in states with access to abortion services will need to collaborate with colleagues in states with restrictions on abortion services to improve patient access across state borders.

On a national level, advancing our effective advocacy in Congress may lead to national legislation passed and signed by the President. This could supersede most state laws prohibiting access to comprehensive women’s reproductive health and create a unified, national approach to abortion care, allowing for the appropriate training of all obstetrician-gynecologists. We will also need to develop teams in every state capable of advocating for laws that ensure access to all reproductive health care options. The American College of Obstetricians and Gynecologists has leaders trained and tasked with legislative advocacy in every state.⁷ This network will be a foundation upon which to build additional advocacy efforts.

As women’s health care professionals, our responsibility to our patients, is to work to ensure universal access to safe and effective comprehensive reproductive options, and to ensure that our workforce is prepared to meet the needs of our patients by defending the patient-clinician relationship. Abortion care saves lives of pregnant patients and reduces maternal morbidity.⁸ Access to safe abortion care as part of comprehensive reproductive services is an important component of health care. ●

The American College of Obstetricians and Gynecologists’ 36th annual Congressional Leadership Conference was held in Washington March 11-13 with the theme “Facts are important: Women’s health is no exception.”

Approximately 630 fellows, junior fellows, and medical students attended, with 50% of those present being junior fellows. Another 50% were at the CLC for the first time. Forty-nine states were represented. There were a total of 359 meetings with members of Congress, including senators and representatives.

The first day and a half was spent learning about advocacy and current women’s health issues that should be addressed by Congress. Rep. Jaime Herrera Beutler (R-Wash.) discussed her cosponsorship of the House bill, H.R. 1318, the “Preventing Maternal Deaths Act.” The bill authorizes the CDC to provide $7 million annually for grants to states for Maternal Mortality Review Committees (MMRC) in order to create, expand, or support a committee that will collect data so the causes of maternal mortality can be determined and reviewed in each state.

One of the two “asks” for the CLC attendees was to discuss maternal mortality and ask their representatives to cosponsor H.R. 1318 and their senators to cosponsor S. 1112, the “Maternal Health Accountability Act.”

With more women dying from pregnancy complications in the United States than any other developed country, maternal mortality needs to be assessed. Currently 33 states have MMRC while 11 states and the District of Columbia are in the process of establishing the committee.

The rate of maternal mortality has increased from 18.8 maternal deaths per 100,000 live births in 2000 to 23.8 per 100,000 in 2014. African American women are three to four times more likely than non-Hispanic white women to die of pregnancy-related or associated complications in the United States. Causes of maternal death include preeclampsia, hemorrhage, overdosage, and suicide with the leading cause varying from one state to the next.

Sara Rosenbaum, professor of health law and policy at George Washington University, Washington, presented “Medicaid. Facts Matter to Women’s Health.” Rebekah Gee, MD, secretary of the Louisiana Department of Health discussed health care from a state’s perspective.

Dr. Bohon is an ob.gyn. in private practice in Washington. She is an ACOG state legislative chair from the District of Columbia and a member of the Ob.Gyn. News Editorial Advisory Board. She reported having no relevant financial disclosures. Dr. Cuff of the Medical University of South Carolina, Charleston, is the current chair of the Junior Fellow Congress Advisory Council of ACOG.

The American College of Obstetricians and Gynecologists’ 36th annual Congressional Leadership Conference was held in Washington March 11-13 with the theme “Facts are important: Women’s health is no exception.”

Approximately 630 fellows, junior fellows, and medical students attended, with 50% of those present being junior fellows. Another 50% were at the CLC for the first time. Forty-nine states were represented. There were a total of 359 meetings with members of Congress, including senators and representatives.

The first day and a half was spent learning about advocacy and current women’s health issues that should be addressed by Congress. Rep. Jaime Herrera Beutler (R-Wash.) discussed her cosponsorship of the House bill, H.R. 1318, the “Preventing Maternal Deaths Act.” The bill authorizes the CDC to provide $7 million annually for grants to states for Maternal Mortality Review Committees (MMRC) in order to create, expand, or support a committee that will collect data so the causes of maternal mortality can be determined and reviewed in each state.

One of the two “asks” for the CLC attendees was to discuss maternal mortality and ask their representatives to cosponsor H.R. 1318 and their senators to cosponsor S. 1112, the “Maternal Health Accountability Act.”

With more women dying from pregnancy complications in the United States than any other developed country, maternal mortality needs to be assessed. Currently 33 states have MMRC while 11 states and the District of Columbia are in the process of establishing the committee.

The rate of maternal mortality has increased from 18.8 maternal deaths per 100,000 live births in 2000 to 23.8 per 100,000 in 2014. African American women are three to four times more likely than non-Hispanic white women to die of pregnancy-related or associated complications in the United States. Causes of maternal death include preeclampsia, hemorrhage, overdosage, and suicide with the leading cause varying from one state to the next.

Sara Rosenbaum, professor of health law and policy at George Washington University, Washington, presented “Medicaid. Facts Matter to Women’s Health.” Rebekah Gee, MD, secretary of the Louisiana Department of Health discussed health care from a state’s perspective.

Dr. Bohon is an ob.gyn. in private practice in Washington. She is an ACOG state legislative chair from the District of Columbia and a member of the Ob.Gyn. News Editorial Advisory Board. She reported having no relevant financial disclosures. Dr. Cuff of the Medical University of South Carolina, Charleston, is the current chair of the Junior Fellow Congress Advisory Council of ACOG.

The American College of Obstetricians and Gynecologists’ 36th annual Congressional Leadership Conference was held in Washington March 11-13 with the theme “Facts are important: Women’s health is no exception.”

Approximately 630 fellows, junior fellows, and medical students attended, with 50% of those present being junior fellows. Another 50% were at the CLC for the first time. Forty-nine states were represented. There were a total of 359 meetings with members of Congress, including senators and representatives.

The first day and a half was spent learning about advocacy and current women’s health issues that should be addressed by Congress. Rep. Jaime Herrera Beutler (R-Wash.) discussed her cosponsorship of the House bill, H.R. 1318, the “Preventing Maternal Deaths Act.” The bill authorizes the CDC to provide $7 million annually for grants to states for Maternal Mortality Review Committees (MMRC) in order to create, expand, or support a committee that will collect data so the causes of maternal mortality can be determined and reviewed in each state.

One of the two “asks” for the CLC attendees was to discuss maternal mortality and ask their representatives to cosponsor H.R. 1318 and their senators to cosponsor S. 1112, the “Maternal Health Accountability Act.”

With more women dying from pregnancy complications in the United States than any other developed country, maternal mortality needs to be assessed. Currently 33 states have MMRC while 11 states and the District of Columbia are in the process of establishing the committee.

The rate of maternal mortality has increased from 18.8 maternal deaths per 100,000 live births in 2000 to 23.8 per 100,000 in 2014. African American women are three to four times more likely than non-Hispanic white women to die of pregnancy-related or associated complications in the United States. Causes of maternal death include preeclampsia, hemorrhage, overdosage, and suicide with the leading cause varying from one state to the next.

Sara Rosenbaum, professor of health law and policy at George Washington University, Washington, presented “Medicaid. Facts Matter to Women’s Health.” Rebekah Gee, MD, secretary of the Louisiana Department of Health discussed health care from a state’s perspective.

Dr. Bohon is an ob.gyn. in private practice in Washington. She is an ACOG state legislative chair from the District of Columbia and a member of the Ob.Gyn. News Editorial Advisory Board. She reported having no relevant financial disclosures. Dr. Cuff of the Medical University of South Carolina, Charleston, is the current chair of the Junior Fellow Congress Advisory Council of ACOG.