Overturning Roe: Exacerbating inequities in abortion care and ObGyn training

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Overturning Roe: Exacerbating inequities in abortion care and ObGyn training
Author(s)
Samantha Truong, MD
Emily R. Burdette, MD, MPH
Ellen C. Murphy, MD

 

On a recent overnight shift, our ObGyn on-call team was urgently paged to the emergency room for a patient who was brought in hemorrhaging after having passed out mid-flight from Texas to Boston. She was 12-weeks pregnant. We rushed her to the operating room for surgical removal of the pregnancy by dilation and curettage to stop her bleeding. Landing in Massachusetts had saved her life.

The significance of this patient’s case was not lost on the multidisciplinary teams caring for her, as the—at the time—impending Roe v Wade decision weighed heavily on our minds. One of many, her story foreshadows the harrowing experiences that we anticipate in the coming months and highlights the danger that the Supreme Court has inflicted on pregnant people nationally.

The Supreme Court decision on Dobbs v Jackson condemns us as a nation in which abortion rights are no longer federally protected under Roe v Wade.1 Twenty-six states have been poised to ban abortion, and in at least 12 states, abortion is now illegal.2,3 Political decision making will soon deny pregnant people the right to bodily autonomy, and the United States will lag behind other nations in abortion access.4 As ObGyn resident physicians who practice in tertiary referral hospitals in Massachusetts, where the ROE Act protects abortion beyond 24 weeks’ gestational age, we affirm abortion as essential health care that saves lives.5

Collectively as physician residents, we have provided an abortion for the patient at 22 weeks with a desired pregnancy who would have otherwise died from high blood pressures, the patient who ended her pregnancy to expedite breast cancer treatment, and the 16-year-old who feared for her life after suffering an assault by her partner for disclosing her pregnancy. With the overturn of Roe v Wade, patients like these will suffer dramatically divergent fates as race, class, and, now more than ever, geography will impact who is able to access abortion care.

Ramifications of the overturn of Roe

History foreshadows the grim impact of repealing Roe. Ohio’s 2011 law that requires the use of the restrictive protocol approved by the US Food and Drug Administration for mifepristone administration deepened existing inequities in abortion access.6 Patients with private insurance, higher income, higher level of education, and those who were White were more likely to obtain abortion care.7 In Texas, after the implementation of SB8 and other restrictive laws, Hispanic women whose travel distance increased more than 100 miles had the greatest reduction in abortion rates.8,9 A recent study regarding banning abortion in the United States estimated a 7% increase in pregnancy-related deaths in 1 year, with a 21% increase in subsequent years.10

Inequities in abortion access subsequently will disparately increase deaths of pregnant individuals in certain populations.11,12 Communities with the highest rates of unintended pregnancy, medical comorbidities, and lack of access to abortion, as well as historically marginalized populations—including non-Hispanic Black people, LGBTQIA people, those with limited English proficiency, and undocumented persons—will experience the greatest increase in pregnancy-related deaths due to a total abortion ban.13-15

The US maternal mortality rate is already the highest among developed nations, and it will only climb if ObGyns are not appropriately trained to operate within our full scope of practice and, thus, are unable to provide the highest quality of care.16,17

Continue: Abortion is a medical treatment that requires resident training...

 

 

Abortion is a medical treatment that requires resident training

Abortion care must be protected. Uterine evacuation by medical management, suction curettage, or dilation and evacuation is indicated for undesired pregnancy, regardless of reasoning or life circumstance. Pregnancy carries inherent risks that can at times be deadly.18 Abortion serves as first-line treatment for certain life-threatening pregnancy risks, including septic miscarriage, maternal hemorrhage, early-onset severe preeclampsia, and certain health conditions.19 Surgical skills and medical management of abortion are therefore fundamental components of ObGyn care and residency training.20

In choosing to become ObGyns,and particularly in selecting our training program, the ability to provide safe abortion care was a calculated priority. A recent study on the implications of overturning Roe predicted that nearly half of ObGyn residents will likely or certainly lose access to in-state abortion training.21 As demonstrated already in states with restrictive abortion laws, we will lose an entire generation of medical professionals skilled in performing this lifesaving procedure.9,22 While privileged patients may travel across state borders to access care, ObGyn and other medical trainees who are contract bound to residency programs do not have such flexibility to seek out abortion training. Although we hope the reversal of Roe will be fleeting, the consequences of this lost generation are irreparable.23,24 For physicians like ourselves, who fortunately are trained in surgical abortions and safe management of medical terminations, the discrepancy between evidence-based guidelines and impending political restrictions is distressing. We are forced to imagine refusing patients necessary health care—or face incarceration to save their lives.

The idea of watching a patient die, whether by hemorrhage, sepsis, or suicide, while armed with the tools of safe abortion technique is horrific. As authors with roots in Texas, Michigan, and Georgia, where abortion has or will almost certainly become illegal now that Roe v Wade is overturned, this scene is personal. It affects our future patients, our families, our colleagues, and our ability to return to our home states to live and practice.

Political organizing is critical to protect and restore abortion rights and defend against conservative coercive politics.25 Nearly half of pregnancies in the United States are unintended, and more than half of these end in abortion.26,27 Threats to abortion access require action from every one of the 59% of Americans who believe abortion should remain legal.28 This is especially important from a social and racial justice perspective as abortion bans will disproportionately affect marginalized groups and further exacerbate inequities in maternal mortality.13

Call to action

Now is the time for community action for reproductive justice and human rights. We urge everyone to donate to abortion funds, vote for leaders who support reproductive justice, and petition your state legislators to codify Roe into law. Now is the time to expand legislation to protect abortion providers and our patients. To ObGyns, family medicine physicians, internists, and other reproductive health clinicians, now is the time to maximize your abortion training. Now is the time to act; otherwise, pregnant individuals will die and future generations of physicians will not have the training to save their lives. ●

References

 

  1. de Vogue A, Sneed T, Duster C, et al. Supreme Court overturns Roe v Wade. CNN Politics. June 24, 2022. Accessed July 19, 2022. https://www.cnn.com/2022/06/24/politics/dobbs-missis sippi-supreme-court-abortion-roe-wade/index.html
  2. Nash E, Cross L. 26 States are certain or likely to ban abortion without Roe: here’s which ones and why. Guttmacher Institute. October 28, 2021. Updated April 19, 2022. Accessed July 19, 2022. https://www.guttmacher.org/article/2021/10/26-states-are-certain-or-likely-ban-abortion-without-roe-heres-which-ones-and-why
  3. Messerly M. Abortion laws by state: where abortions are illegal after Roe v Wade overturned. Politico. June 24, 2022. Accessed July 19, 2022. https://www.politico.com/news/2022/06/24/abortion-laws-by-state-roe-v-wade-00037695
  4. Archie A. US would lag behind global abortion access if Roe v Wade is undone, advocates say. NPR. May 5, 2022. Accessed July 19, 2022. https://www.npr.org/2022/05/05/1096805490/abortion-access-supreme-court-roe-v-wade-united-nations
  5. Romo V. Massachusetts senate overrides veto, passes law expanding abortion access. NPR. December 29, 2020. Accessed July 19, 2022. https://www.npr.org/2020/12/29/951259506/massachusetts-senate-overrides-veto-passes-law-expanding-abortion-access
  6. Upadhyay UD, Johns NE, Combellick SL, et al. Comparison of outcomes before and after Ohio’s law mandating use of the FDA-approved protocol for medication abortion: a retrospective cohort study. PLoS Med. 2016;13:e1002110.
  7. Upadhyay UD, Johns NE, Cartwright AF, et al. Sociodemographic characteristics of women able to obtain medication abortion before and after Ohio’s law requiring use of the Food and Drug Administration protocol. Health Equity. 2018;2:122-130.
  8. Goyal V, Brooks IHM, Powers DA. Differences in abortion rates by race-ethnicity after implementation of a restrictive Texas law. Contraception. 2020;102:109-114.
  9. Noyes E Holder BH, Evans ML. Texas SB8 and the future of abortion care. OBG Manag. 2021;33. doi:12788/obgm.0151.
  10. Vilda D, Wallace ME, Daniel C, et al. State abortion policies and maternal death in the United States, 2015‒2018. Am J Public Health. 2021;111:1696-1704.
  11. The Lancet. Why Roe v Wade must be defended. Lancet. 2022;399:1845.
  12. Nambiar A, Patel S, Santiago-Munoz P, et al. Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with complications in two Texas hospitals after legislation on abortion. Am J Obstet Gynecol. 2022;227:648-650.e1.
  13. 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;58:20192028.
  14. Medley S. Gutting abortion rights would be devastating for LGBTQ+ people. Them. September 17, 2021. Accessed July 20, 2022. https://www.them.us/story/gutting-abortion-rights-devastating-lgbtq-people
  15. Holter L. Detained immigrant women are facing a grueling abortion struggle. National Latina Institute for Reproductive Justice. May 10, 2017. Accessed July 20, 2022. https://www.latinainsti tute.org/es/node/4620
  16. Haddad LB, Nour NM. Unsafe abortion: unnecessary maternal mortality. Rev Obstet Gynecol. 2009;2:122-126.
  17. Tikkanen R, Gunja MZ, FitzGerald M, et al. Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund. November 18, 2020. Accessed November 17, 2022. https://www .commonwealthfund.org/publications/issue -briefs/2020/nov/maternal-mortality-maternity -care-us-compared-10-countries
  18. Collier A-RY, Molina RL. Maternal mortality in the United States: updates on trends, causes, and solutions. Neoreviews. 2019;20:e561-e574.
  19. ACOG practice bulletin no. 135: Second-trimester abortion. Obstet Gynecol. 2013;121:1394-1406.
  20. Committee on Health Care for Underserved Women. ACOG Committee opinion no. 612: Abortion training and education. Obstet Gynecol. 2014;124:1055-1059.
  21. Vinekar K, Karlapudi A, Nathan L, et al. Projected implications of overturning Roe v Wade on abortion training in US obstetrics and gynecology residency programs. Obstet Gynecol. 2022;140:146-149.
  22. Horvath S, Turk J, Steinauer J, et al. Increase in obstetrics and gynecology resident self-assessed competence in early pregnancy loss management with routine abortion care training. Obstet Gynecol. 2022;139:116-119.
  23. Anderson N. The fall of Roe scrambles abortion training in university hospitals. The Washington Post. June 30, 2022. Accessed July 20, 2022. https://www.washingtonpost.com/educa tion/2022/06/30/abortion-training-upheaval-dobbs/
  24. Weiner S. How the repeal of Roe v Wade will affect training in abortion and reproductive health. AAMC. June 24, 2022. Accessed July 20, 2022. https://www.aamc.org/news-insights/how-repeal-roe-v-wade-will-affect-training-abortion-and-reproductive-health
  25. Dreweke J. Coercion is at the heart of social conservatives’ reproductive health agenda. Guttmacher Institute. February 7, 2018. Accessed July 20, 2022. https://www.guttmacher.org/gpr/2018/02/coercion-heart-social-conservatives-reproduc tive-health-agenda
  26. Unintended pregnancy and abortion worldwide. Guttmacher Institute. March 2022. Accessed July 20, 2022. https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide
  27. Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008–2011. N Engl J Med. 2016;374:843-852.
  28. Hartig H. About six-in-ten Americans say abortion should be legal in all or most cases. Pew Research Center. June 13, 2022. Accessed July 20, 2022. https://www.pewresearch.org/fact-tank/2022/06/13/about-six-in-ten-americans-say-abortion-should-be-legal-in-all-or-most-cases-2/
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Samantha Truong, MD

Dr. Truong is Resident, Obstetrics and Gynecology, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, Massachusetts.

Emily R. Burdette, MD, MPH

Dr. Burdette is Resident, Obstetrics and Gynecology, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston.

Ellen C. Murphy, MD

Dr. Murphy is Resident, Obstetrics and Gynecology, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston.

 

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Emily R. Burdette, MD, MPH
Ellen C. Murphy, MD
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Emily R. Burdette, MD, MPH
Ellen C. Murphy, MD
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Dr. Truong is Resident, Obstetrics and Gynecology, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, Massachusetts.

Emily R. Burdette, MD, MPH

Dr. Burdette is Resident, Obstetrics and Gynecology, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston.

Ellen C. Murphy, MD

Dr. Murphy is Resident, Obstetrics and Gynecology, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston.

 

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Author and Disclosure Information

Samantha Truong, MD

Dr. Truong is Resident, Obstetrics and Gynecology, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, Massachusetts.

Emily R. Burdette, MD, MPH

Dr. Burdette is Resident, Obstetrics and Gynecology, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston.

Ellen C. Murphy, MD

Dr. Murphy is Resident, Obstetrics and Gynecology, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston.

 

The authors report no financial relationships relevant to this article.

Article PDF
obgm03412038_truong.pdf
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On a recent overnight shift, our ObGyn on-call team was urgently paged to the emergency room for a patient who was brought in hemorrhaging after having passed out mid-flight from Texas to Boston. She was 12-weeks pregnant. We rushed her to the operating room for surgical removal of the pregnancy by dilation and curettage to stop her bleeding. Landing in Massachusetts had saved her life.

The significance of this patient’s case was not lost on the multidisciplinary teams caring for her, as the—at the time—impending Roe v Wade decision weighed heavily on our minds. One of many, her story foreshadows the harrowing experiences that we anticipate in the coming months and highlights the danger that the Supreme Court has inflicted on pregnant people nationally.

The Supreme Court decision on Dobbs v Jackson condemns us as a nation in which abortion rights are no longer federally protected under Roe v Wade.1 Twenty-six states have been poised to ban abortion, and in at least 12 states, abortion is now illegal.2,3 Political decision making will soon deny pregnant people the right to bodily autonomy, and the United States will lag behind other nations in abortion access.4 As ObGyn resident physicians who practice in tertiary referral hospitals in Massachusetts, where the ROE Act protects abortion beyond 24 weeks’ gestational age, we affirm abortion as essential health care that saves lives.5

Collectively as physician residents, we have provided an abortion for the patient at 22 weeks with a desired pregnancy who would have otherwise died from high blood pressures, the patient who ended her pregnancy to expedite breast cancer treatment, and the 16-year-old who feared for her life after suffering an assault by her partner for disclosing her pregnancy. With the overturn of Roe v Wade, patients like these will suffer dramatically divergent fates as race, class, and, now more than ever, geography will impact who is able to access abortion care.

Ramifications of the overturn of Roe

History foreshadows the grim impact of repealing Roe. Ohio’s 2011 law that requires the use of the restrictive protocol approved by the US Food and Drug Administration for mifepristone administration deepened existing inequities in abortion access.6 Patients with private insurance, higher income, higher level of education, and those who were White were more likely to obtain abortion care.7 In Texas, after the implementation of SB8 and other restrictive laws, Hispanic women whose travel distance increased more than 100 miles had the greatest reduction in abortion rates.8,9 A recent study regarding banning abortion in the United States estimated a 7% increase in pregnancy-related deaths in 1 year, with a 21% increase in subsequent years.10

Inequities in abortion access subsequently will disparately increase deaths of pregnant individuals in certain populations.11,12 Communities with the highest rates of unintended pregnancy, medical comorbidities, and lack of access to abortion, as well as historically marginalized populations—including non-Hispanic Black people, LGBTQIA people, those with limited English proficiency, and undocumented persons—will experience the greatest increase in pregnancy-related deaths due to a total abortion ban.13-15

The US maternal mortality rate is already the highest among developed nations, and it will only climb if ObGyns are not appropriately trained to operate within our full scope of practice and, thus, are unable to provide the highest quality of care.16,17

Continue: Abortion is a medical treatment that requires resident training...

 

 

Abortion is a medical treatment that requires resident training

Abortion care must be protected. Uterine evacuation by medical management, suction curettage, or dilation and evacuation is indicated for undesired pregnancy, regardless of reasoning or life circumstance. Pregnancy carries inherent risks that can at times be deadly.18 Abortion serves as first-line treatment for certain life-threatening pregnancy risks, including septic miscarriage, maternal hemorrhage, early-onset severe preeclampsia, and certain health conditions.19 Surgical skills and medical management of abortion are therefore fundamental components of ObGyn care and residency training.20

In choosing to become ObGyns,and particularly in selecting our training program, the ability to provide safe abortion care was a calculated priority. A recent study on the implications of overturning Roe predicted that nearly half of ObGyn residents will likely or certainly lose access to in-state abortion training.21 As demonstrated already in states with restrictive abortion laws, we will lose an entire generation of medical professionals skilled in performing this lifesaving procedure.9,22 While privileged patients may travel across state borders to access care, ObGyn and other medical trainees who are contract bound to residency programs do not have such flexibility to seek out abortion training. Although we hope the reversal of Roe will be fleeting, the consequences of this lost generation are irreparable.23,24 For physicians like ourselves, who fortunately are trained in surgical abortions and safe management of medical terminations, the discrepancy between evidence-based guidelines and impending political restrictions is distressing. We are forced to imagine refusing patients necessary health care—or face incarceration to save their lives.

The idea of watching a patient die, whether by hemorrhage, sepsis, or suicide, while armed with the tools of safe abortion technique is horrific. As authors with roots in Texas, Michigan, and Georgia, where abortion has or will almost certainly become illegal now that Roe v Wade is overturned, this scene is personal. It affects our future patients, our families, our colleagues, and our ability to return to our home states to live and practice.

Political organizing is critical to protect and restore abortion rights and defend against conservative coercive politics.25 Nearly half of pregnancies in the United States are unintended, and more than half of these end in abortion.26,27 Threats to abortion access require action from every one of the 59% of Americans who believe abortion should remain legal.28 This is especially important from a social and racial justice perspective as abortion bans will disproportionately affect marginalized groups and further exacerbate inequities in maternal mortality.13

Call to action

Now is the time for community action for reproductive justice and human rights. We urge everyone to donate to abortion funds, vote for leaders who support reproductive justice, and petition your state legislators to codify Roe into law. Now is the time to expand legislation to protect abortion providers and our patients. To ObGyns, family medicine physicians, internists, and other reproductive health clinicians, now is the time to maximize your abortion training. Now is the time to act; otherwise, pregnant individuals will die and future generations of physicians will not have the training to save their lives. ●

 

On a recent overnight shift, our ObGyn on-call team was urgently paged to the emergency room for a patient who was brought in hemorrhaging after having passed out mid-flight from Texas to Boston. She was 12-weeks pregnant. We rushed her to the operating room for surgical removal of the pregnancy by dilation and curettage to stop her bleeding. Landing in Massachusetts had saved her life.

The significance of this patient’s case was not lost on the multidisciplinary teams caring for her, as the—at the time—impending Roe v Wade decision weighed heavily on our minds. One of many, her story foreshadows the harrowing experiences that we anticipate in the coming months and highlights the danger that the Supreme Court has inflicted on pregnant people nationally.

The Supreme Court decision on Dobbs v Jackson condemns us as a nation in which abortion rights are no longer federally protected under Roe v Wade.1 Twenty-six states have been poised to ban abortion, and in at least 12 states, abortion is now illegal.2,3 Political decision making will soon deny pregnant people the right to bodily autonomy, and the United States will lag behind other nations in abortion access.4 As ObGyn resident physicians who practice in tertiary referral hospitals in Massachusetts, where the ROE Act protects abortion beyond 24 weeks’ gestational age, we affirm abortion as essential health care that saves lives.5

Collectively as physician residents, we have provided an abortion for the patient at 22 weeks with a desired pregnancy who would have otherwise died from high blood pressures, the patient who ended her pregnancy to expedite breast cancer treatment, and the 16-year-old who feared for her life after suffering an assault by her partner for disclosing her pregnancy. With the overturn of Roe v Wade, patients like these will suffer dramatically divergent fates as race, class, and, now more than ever, geography will impact who is able to access abortion care.

Ramifications of the overturn of Roe

History foreshadows the grim impact of repealing Roe. Ohio’s 2011 law that requires the use of the restrictive protocol approved by the US Food and Drug Administration for mifepristone administration deepened existing inequities in abortion access.6 Patients with private insurance, higher income, higher level of education, and those who were White were more likely to obtain abortion care.7 In Texas, after the implementation of SB8 and other restrictive laws, Hispanic women whose travel distance increased more than 100 miles had the greatest reduction in abortion rates.8,9 A recent study regarding banning abortion in the United States estimated a 7% increase in pregnancy-related deaths in 1 year, with a 21% increase in subsequent years.10

Inequities in abortion access subsequently will disparately increase deaths of pregnant individuals in certain populations.11,12 Communities with the highest rates of unintended pregnancy, medical comorbidities, and lack of access to abortion, as well as historically marginalized populations—including non-Hispanic Black people, LGBTQIA people, those with limited English proficiency, and undocumented persons—will experience the greatest increase in pregnancy-related deaths due to a total abortion ban.13-15

The US maternal mortality rate is already the highest among developed nations, and it will only climb if ObGyns are not appropriately trained to operate within our full scope of practice and, thus, are unable to provide the highest quality of care.16,17

Continue: Abortion is a medical treatment that requires resident training...

 

 

Abortion is a medical treatment that requires resident training

Abortion care must be protected. Uterine evacuation by medical management, suction curettage, or dilation and evacuation is indicated for undesired pregnancy, regardless of reasoning or life circumstance. Pregnancy carries inherent risks that can at times be deadly.18 Abortion serves as first-line treatment for certain life-threatening pregnancy risks, including septic miscarriage, maternal hemorrhage, early-onset severe preeclampsia, and certain health conditions.19 Surgical skills and medical management of abortion are therefore fundamental components of ObGyn care and residency training.20

In choosing to become ObGyns,and particularly in selecting our training program, the ability to provide safe abortion care was a calculated priority. A recent study on the implications of overturning Roe predicted that nearly half of ObGyn residents will likely or certainly lose access to in-state abortion training.21 As demonstrated already in states with restrictive abortion laws, we will lose an entire generation of medical professionals skilled in performing this lifesaving procedure.9,22 While privileged patients may travel across state borders to access care, ObGyn and other medical trainees who are contract bound to residency programs do not have such flexibility to seek out abortion training. Although we hope the reversal of Roe will be fleeting, the consequences of this lost generation are irreparable.23,24 For physicians like ourselves, who fortunately are trained in surgical abortions and safe management of medical terminations, the discrepancy between evidence-based guidelines and impending political restrictions is distressing. We are forced to imagine refusing patients necessary health care—or face incarceration to save their lives.

The idea of watching a patient die, whether by hemorrhage, sepsis, or suicide, while armed with the tools of safe abortion technique is horrific. As authors with roots in Texas, Michigan, and Georgia, where abortion has or will almost certainly become illegal now that Roe v Wade is overturned, this scene is personal. It affects our future patients, our families, our colleagues, and our ability to return to our home states to live and practice.

Political organizing is critical to protect and restore abortion rights and defend against conservative coercive politics.25 Nearly half of pregnancies in the United States are unintended, and more than half of these end in abortion.26,27 Threats to abortion access require action from every one of the 59% of Americans who believe abortion should remain legal.28 This is especially important from a social and racial justice perspective as abortion bans will disproportionately affect marginalized groups and further exacerbate inequities in maternal mortality.13

Call to action

Now is the time for community action for reproductive justice and human rights. We urge everyone to donate to abortion funds, vote for leaders who support reproductive justice, and petition your state legislators to codify Roe into law. Now is the time to expand legislation to protect abortion providers and our patients. To ObGyns, family medicine physicians, internists, and other reproductive health clinicians, now is the time to maximize your abortion training. Now is the time to act; otherwise, pregnant individuals will die and future generations of physicians will not have the training to save their lives. ●

References

 

  1. de Vogue A, Sneed T, Duster C, et al. Supreme Court overturns Roe v Wade. CNN Politics. June 24, 2022. Accessed July 19, 2022. https://www.cnn.com/2022/06/24/politics/dobbs-missis sippi-supreme-court-abortion-roe-wade/index.html
  2. Nash E, Cross L. 26 States are certain or likely to ban abortion without Roe: here’s which ones and why. Guttmacher Institute. October 28, 2021. Updated April 19, 2022. Accessed July 19, 2022. https://www.guttmacher.org/article/2021/10/26-states-are-certain-or-likely-ban-abortion-without-roe-heres-which-ones-and-why
  3. Messerly M. Abortion laws by state: where abortions are illegal after Roe v Wade overturned. Politico. June 24, 2022. Accessed July 19, 2022. https://www.politico.com/news/2022/06/24/abortion-laws-by-state-roe-v-wade-00037695
  4. Archie A. US would lag behind global abortion access if Roe v Wade is undone, advocates say. NPR. May 5, 2022. Accessed July 19, 2022. https://www.npr.org/2022/05/05/1096805490/abortion-access-supreme-court-roe-v-wade-united-nations
  5. Romo V. Massachusetts senate overrides veto, passes law expanding abortion access. NPR. December 29, 2020. Accessed July 19, 2022. https://www.npr.org/2020/12/29/951259506/massachusetts-senate-overrides-veto-passes-law-expanding-abortion-access
  6. Upadhyay UD, Johns NE, Combellick SL, et al. Comparison of outcomes before and after Ohio’s law mandating use of the FDA-approved protocol for medication abortion: a retrospective cohort study. PLoS Med. 2016;13:e1002110.
  7. Upadhyay UD, Johns NE, Cartwright AF, et al. Sociodemographic characteristics of women able to obtain medication abortion before and after Ohio’s law requiring use of the Food and Drug Administration protocol. Health Equity. 2018;2:122-130.
  8. Goyal V, Brooks IHM, Powers DA. Differences in abortion rates by race-ethnicity after implementation of a restrictive Texas law. Contraception. 2020;102:109-114.
  9. Noyes E Holder BH, Evans ML. Texas SB8 and the future of abortion care. OBG Manag. 2021;33. doi:12788/obgm.0151.
  10. Vilda D, Wallace ME, Daniel C, et al. State abortion policies and maternal death in the United States, 2015‒2018. Am J Public Health. 2021;111:1696-1704.
  11. The Lancet. Why Roe v Wade must be defended. Lancet. 2022;399:1845.
  12. Nambiar A, Patel S, Santiago-Munoz P, et al. Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with complications in two Texas hospitals after legislation on abortion. Am J Obstet Gynecol. 2022;227:648-650.e1.
  13. 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;58:20192028.
  14. Medley S. Gutting abortion rights would be devastating for LGBTQ+ people. Them. September 17, 2021. Accessed July 20, 2022. https://www.them.us/story/gutting-abortion-rights-devastating-lgbtq-people
  15. Holter L. Detained immigrant women are facing a grueling abortion struggle. National Latina Institute for Reproductive Justice. May 10, 2017. Accessed July 20, 2022. https://www.latinainsti tute.org/es/node/4620
  16. Haddad LB, Nour NM. Unsafe abortion: unnecessary maternal mortality. Rev Obstet Gynecol. 2009;2:122-126.
  17. Tikkanen R, Gunja MZ, FitzGerald M, et al. Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund. November 18, 2020. Accessed November 17, 2022. https://www .commonwealthfund.org/publications/issue -briefs/2020/nov/maternal-mortality-maternity -care-us-compared-10-countries
  18. Collier A-RY, Molina RL. Maternal mortality in the United States: updates on trends, causes, and solutions. Neoreviews. 2019;20:e561-e574.
  19. ACOG practice bulletin no. 135: Second-trimester abortion. Obstet Gynecol. 2013;121:1394-1406.
  20. Committee on Health Care for Underserved Women. ACOG Committee opinion no. 612: Abortion training and education. Obstet Gynecol. 2014;124:1055-1059.
  21. Vinekar K, Karlapudi A, Nathan L, et al. Projected implications of overturning Roe v Wade on abortion training in US obstetrics and gynecology residency programs. Obstet Gynecol. 2022;140:146-149.
  22. Horvath S, Turk J, Steinauer J, et al. Increase in obstetrics and gynecology resident self-assessed competence in early pregnancy loss management with routine abortion care training. Obstet Gynecol. 2022;139:116-119.
  23. Anderson N. The fall of Roe scrambles abortion training in university hospitals. The Washington Post. June 30, 2022. Accessed July 20, 2022. https://www.washingtonpost.com/educa tion/2022/06/30/abortion-training-upheaval-dobbs/
  24. Weiner S. How the repeal of Roe v Wade will affect training in abortion and reproductive health. AAMC. June 24, 2022. Accessed July 20, 2022. https://www.aamc.org/news-insights/how-repeal-roe-v-wade-will-affect-training-abortion-and-reproductive-health
  25. Dreweke J. Coercion is at the heart of social conservatives’ reproductive health agenda. Guttmacher Institute. February 7, 2018. Accessed July 20, 2022. https://www.guttmacher.org/gpr/2018/02/coercion-heart-social-conservatives-reproduc tive-health-agenda
  26. Unintended pregnancy and abortion worldwide. Guttmacher Institute. March 2022. Accessed July 20, 2022. https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide
  27. Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008–2011. N Engl J Med. 2016;374:843-852.
  28. Hartig H. About six-in-ten Americans say abortion should be legal in all or most cases. Pew Research Center. June 13, 2022. Accessed July 20, 2022. https://www.pewresearch.org/fact-tank/2022/06/13/about-six-in-ten-americans-say-abortion-should-be-legal-in-all-or-most-cases-2/
References

 

  1. de Vogue A, Sneed T, Duster C, et al. Supreme Court overturns Roe v Wade. CNN Politics. June 24, 2022. Accessed July 19, 2022. https://www.cnn.com/2022/06/24/politics/dobbs-missis sippi-supreme-court-abortion-roe-wade/index.html
  2. Nash E, Cross L. 26 States are certain or likely to ban abortion without Roe: here’s which ones and why. Guttmacher Institute. October 28, 2021. Updated April 19, 2022. Accessed July 19, 2022. https://www.guttmacher.org/article/2021/10/26-states-are-certain-or-likely-ban-abortion-without-roe-heres-which-ones-and-why
  3. Messerly M. Abortion laws by state: where abortions are illegal after Roe v Wade overturned. Politico. June 24, 2022. Accessed July 19, 2022. https://www.politico.com/news/2022/06/24/abortion-laws-by-state-roe-v-wade-00037695
  4. Archie A. US would lag behind global abortion access if Roe v Wade is undone, advocates say. NPR. May 5, 2022. Accessed July 19, 2022. https://www.npr.org/2022/05/05/1096805490/abortion-access-supreme-court-roe-v-wade-united-nations
  5. Romo V. Massachusetts senate overrides veto, passes law expanding abortion access. NPR. December 29, 2020. Accessed July 19, 2022. https://www.npr.org/2020/12/29/951259506/massachusetts-senate-overrides-veto-passes-law-expanding-abortion-access
  6. Upadhyay UD, Johns NE, Combellick SL, et al. Comparison of outcomes before and after Ohio’s law mandating use of the FDA-approved protocol for medication abortion: a retrospective cohort study. PLoS Med. 2016;13:e1002110.
  7. Upadhyay UD, Johns NE, Cartwright AF, et al. Sociodemographic characteristics of women able to obtain medication abortion before and after Ohio’s law requiring use of the Food and Drug Administration protocol. Health Equity. 2018;2:122-130.
  8. Goyal V, Brooks IHM, Powers DA. Differences in abortion rates by race-ethnicity after implementation of a restrictive Texas law. Contraception. 2020;102:109-114.
  9. Noyes E Holder BH, Evans ML. Texas SB8 and the future of abortion care. OBG Manag. 2021;33. doi:12788/obgm.0151.
  10. Vilda D, Wallace ME, Daniel C, et al. State abortion policies and maternal death in the United States, 2015‒2018. Am J Public Health. 2021;111:1696-1704.
  11. The Lancet. Why Roe v Wade must be defended. Lancet. 2022;399:1845.
  12. Nambiar A, Patel S, Santiago-Munoz P, et al. Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with complications in two Texas hospitals after legislation on abortion. Am J Obstet Gynecol. 2022;227:648-650.e1.
  13. 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;58:20192028.
  14. Medley S. Gutting abortion rights would be devastating for LGBTQ+ people. Them. September 17, 2021. Accessed July 20, 2022. https://www.them.us/story/gutting-abortion-rights-devastating-lgbtq-people
  15. Holter L. Detained immigrant women are facing a grueling abortion struggle. National Latina Institute for Reproductive Justice. May 10, 2017. Accessed July 20, 2022. https://www.latinainsti tute.org/es/node/4620
  16. Haddad LB, Nour NM. Unsafe abortion: unnecessary maternal mortality. Rev Obstet Gynecol. 2009;2:122-126.
  17. Tikkanen R, Gunja MZ, FitzGerald M, et al. Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund. November 18, 2020. Accessed November 17, 2022. https://www .commonwealthfund.org/publications/issue -briefs/2020/nov/maternal-mortality-maternity -care-us-compared-10-countries
  18. Collier A-RY, Molina RL. Maternal mortality in the United States: updates on trends, causes, and solutions. Neoreviews. 2019;20:e561-e574.
  19. ACOG practice bulletin no. 135: Second-trimester abortion. Obstet Gynecol. 2013;121:1394-1406.
  20. Committee on Health Care for Underserved Women. ACOG Committee opinion no. 612: Abortion training and education. Obstet Gynecol. 2014;124:1055-1059.
  21. Vinekar K, Karlapudi A, Nathan L, et al. Projected implications of overturning Roe v Wade on abortion training in US obstetrics and gynecology residency programs. Obstet Gynecol. 2022;140:146-149.
  22. Horvath S, Turk J, Steinauer J, et al. Increase in obstetrics and gynecology resident self-assessed competence in early pregnancy loss management with routine abortion care training. Obstet Gynecol. 2022;139:116-119.
  23. Anderson N. The fall of Roe scrambles abortion training in university hospitals. The Washington Post. June 30, 2022. Accessed July 20, 2022. https://www.washingtonpost.com/educa tion/2022/06/30/abortion-training-upheaval-dobbs/
  24. Weiner S. How the repeal of Roe v Wade will affect training in abortion and reproductive health. AAMC. June 24, 2022. Accessed July 20, 2022. https://www.aamc.org/news-insights/how-repeal-roe-v-wade-will-affect-training-abortion-and-reproductive-health
  25. Dreweke J. Coercion is at the heart of social conservatives’ reproductive health agenda. Guttmacher Institute. February 7, 2018. Accessed July 20, 2022. https://www.guttmacher.org/gpr/2018/02/coercion-heart-social-conservatives-reproduc tive-health-agenda
  26. Unintended pregnancy and abortion worldwide. Guttmacher Institute. March 2022. Accessed July 20, 2022. https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide
  27. Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008–2011. N Engl J Med. 2016;374:843-852.
  28. Hartig H. About six-in-ten Americans say abortion should be legal in all or most cases. Pew Research Center. June 13, 2022. Accessed July 20, 2022. https://www.pewresearch.org/fact-tank/2022/06/13/about-six-in-ten-americans-say-abortion-should-be-legal-in-all-or-most-cases-2/
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