The Impending Crisis of Access to Safe Abortion Care in the US

Abstract

If the recently leaked ruling from the US Supreme Court in Dobbs v. Jackson Women's Health Organization is any indication of the future of abortion care in the US, Roe v. Wade will soon no longer be the law of the land, and access to care will be determined by state laws. It is estimated that about half of states will ban abortion, putting an essential, time-sensitive component of comprehensive health care out of reach. 1 People needing abortions in states with bans will have few options: seek abortion in other states, self-manage their abortion, or carry the pregnancy to term. States where abortion remains legal and accessible will likely see an influx of patients seeking care, perhaps traveling 500 miles or more. For many, this journey will not be possible. As most people obtaining abortions in the US have incomes less than 200% of the federal poverty level, 2 long-distance travel will be a major obstacle. The tremendous financial and other support provided by organizations that facilitate the timely referral of patients will be unable to meet the need.Self-managed (or self-induced) abortion looks very different in 2022 than it did during the pre-Roe era, when people commonly inserted objects into the cervix or ingested toxic substances. The advent of medication abortion, using mifepristone and misoprostol in combination or misoprostol alone, allows people to safely and effectively end pregnancy with the same regimens used in a clinic or medical office (Table ). [3][4][5][6][7] Provided people have information about how to use these medications correctly, including how to screen for eligibility, the medical risks of self-managed abortion are likely to be minimal; however, the legal risks may be substantial. As of 2018, more than 20 people reportedly have been criminally investigated, arrested, or imprisoned in the US for allegedly selfmanaging their abortion or helping someone else do so. 8 People have been charged with various crimes, including homicide, criminal abortion, aggravated fetal assault, procuring a miscarriage, and improper disposal of fetal remains. 8 As the legal environment becomes more restrictive, the frequency of criminal charges against people suspected of self-managing their abortion is likely to increase. It is also possible that people who merely experience pregnancy loss may face criminal charges, as the clinical presentation of spontaneous miscarriage is often identical to the presentation of abortion induced with medication. 9 Most people living in states that ban abortion who would have sought the procedure if it were available will likely be forced to continue their pregnancy to term. Compared with abortion, continuing a pregnancy is associated with increased morbidity and mortality. 10,11 According to one estimate, a total ban on abortion would be followed by a projected 21% increase in maternal mortality overall and a Box. Resources to Assist Patients Seeking Information About Abortion Care or Legal SupportNational Abortion Federation Hotline: information about abortion care prov...

Looking for a Silver Lining to the Dark Cloud: A Google Trends Analysis of Contraceptive Interest in the United States Post Roe vs. Wade Verdict

“…This decision, which sparked sharp reactions within the US and globally, could have deep social ramifications and potentially impact the reproductive health of millions of people, especially women [2,3]. Moreover, this ruling threatens to precipitate further the impending crisis of access to safe abortion care in the United States [4,5]. In the background of this watershed event, we performed a Google Trends analysis to identify the impact of this decision on search interests regarding contraceptive choices in the US.…”

The immediate post-Roe landscape

“…Within hours of the SCOTUS leak on 2 May, internet searches for abortion medicines rocketed, more frequently in states with greater abortion restrictions 5. A list of helplines to assist those seeking abortion has recently been published 6. There has also been increased demand for emergency contraception, with some retailers now imposing rationing 7.…”

“…It has been estimated that 202/790 (26%) of US abortion facilities will be forced to close down 8. Conventional access to abortion through health professionals will now be impossible in many states, although a harm-reduction clinical management approach can be adopted 6. The entirely predictable direct effect of the situation imposed on US residents is that the rate of unsafe abortion will rise, leading to increased morbidity from abortion-related complications.…”

“…5 A list of helplines to assist those seeking abortion has recently been published. 6 There has also been increased demand for emergency contraception, with some retailers now imposing rationing. 7 More than half of purchasers have been buying more than one pack, indicating their intent to plan for the future and retain some control over their fertility.…”

“…8 Conventional access to abortion through health professionals will now be impossible in many states, although a harm-reduction clinical management approach can be adopted. 6 The entirely predictable direct effect of the situation imposed on US residents is that the rate of unsafe abortion will rise, leading to increased morbidity from abortion-related complications. There will also be higher numbers of pregnancy-related complications and maternal mortality will rise.…”