Health Care Access and Reproductive Rights

Abstract

Evidence-based care for early pregnancy is well established and includes strong evidence for safe abortion as part of the reproductive health care spectrum. 1 Legal interference to provision of safe, accessible abortion diverts the time, attention, and skills of clinicians from other pressing health concerns, especially improving maternal health and birth equity. The rate of maternal mortality in the US, already unacceptably high, surged from 20.1 deaths per 100 000 live births in 2019 to 23.8 deaths per 100 000 live births in 2020; the increases were significantly higher for Black and Hispanic people. 2 Maternal deaths (during pregnancy or within 42 days of the end of pregnancy from any cause related to or aggravated by the pregnancy or its management) are anticipated to increase as evolving abortion restriction laws undermine physicians' ethical and professional mandate to prioritize patients' well-being.Nationally, Black individuals are 3 times more likely than White individuals to die of pregnancy-related causes. 3 Legal interference with evidence-based abortion counseling and care will disproportionately affect Black and Hispanic individuals as well as all persons for whom low income, lack of health insurance, or other life circumstances (eg, related to employment, transportation, or family care responsibilities) pose a barrier for access to legal abortion services. Current estimates are that two-thirds of maternal deaths are preventable; the proportion of preventable maternal deaths will increase following the Supreme Court decision in Dobbs v Jackson Women's Health Organization.Beyond reproductive care, legal interference with clinical care makes it difficult for other groups of patients to receive evidence-based care, including access to medications such as methotrexate (widely used to treat rheumatoid arthritis), isotretinoin (used to treat nodular acne), and valproate (used to treat seizures). In addition, the Dobbs decision may create a barrier to an essential component of cancer care for adolescents and young adults with new cancer diagnoses, such as lymphomas, leukemias, sarcomas, and breast or reproductive tract cancers. These patients may no longer have access to standard fertility preservation techniques (eg, genetic testing, sperm and embryo cryopreservation, and embryo disposal). 4 The legal interference may have implications beyond current practice as clinicians-faced with a markedly heightened risk of criminalization by providing routine outpatient, inpatient, emergency, or critical care-alter their current pattern of care.

Looking Back and Moving Forward—JAMA 2022 Year in Review

“…As the COVID-19 pandemic continued in 2022, original research on COVID-19 and reflections on the implications of the pandemic for science and medicine continued to dominate much of the scientific content at JAMA . But we also tackled other major threats to health, including theme issues on gun violence and on health care access and reproductive rights, and the trials, observational studies, and policy analyses we published provided evidence on a range of important issues from the care of critically ill patients to outpatient management of obesity. We also remained committed to the publication of evidence synthesis and guidelines that inform the practice of medicine, publishing 32 reports from the US Preventive Services Task Force, including Recommendation Statements, Evidence Reviews, Modeling Studies, and other articles related to screening or interventions for common diseases and disorders.…”

The Impact of Dobbs on Health Care Beyond Wanted Abortion Care

“…In states with abortion bans, patients are facing obstacles to accessing standard medical care, "including access to medications such as methotrexate (widely used to treat rheumatoid arthritis), isotretinoin (used to treat nodular acne), and valproate (used to treat seizures)." 54 Post-Dobbs, reports quickly surfaced of patients with autoimmune diseases and rheumatological conditions facing hurdles to accessing their medications. For example, Becky Schwarz, who lives with lupus, was notified by her rheumatologist that they would stop all refills of methotrexate because it is considered an abortifacient.…”

Trail Magic

“…For those clinicians, patients, and advocates traversing the challenges of the post- Dobbs landscape (after the US Supreme Court ruling in Dobbs v Jackson Women’s Health Organization ), we encounter our own forms of trail magic. Acts of kindness when morale is low, unexpected allies that make our job easier, and colleagues that support us through the hardest days.…”