21 August 2022: Medical advisory for anti-abortion states

Medical advisory for anti-abortion states 

21 August 2022

 

Pregnant women and girls may want to avoid traveling to anti-abortion states because of adverse health outcomes if they have a medical emergency. See https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html to determine the current status of each state, but note that this changes frequently due to litigation. Prior to the Dobbs v. Jackson Women's Health Organization decision of the U.S. Supreme Court (see https://en.wikipedia.org/wiki/Dobbs_v._Jackson_Women%27s_Health_Organization), female patients could rely on a  standard of care that prioritized their health in medical decision making. However, in anti-abortion states, physicians, nurses, pharmacists and other health care personnel now have to consider whether their actions will subject them to criminal prosecution under the anti-abortion laws.

This threat of criminal prosecution is real. In Indiana, its Attorney General threatened an ob-gyn who performed an abortion on a 10 year old from Ohio, even though it was clearly legal at the time (https://thehill.com/homenews/state-watch/3559347-indiana-ag-threatens-license-of-doctor-who-provided-abortion-to-10-year-old-rape-victim/). There is no doubt that some other prosecutors, who are typically elected officials, will use cases to attempt to advance their political careers.

 

How does the threat of prosecution alter care of pregnant patients? Some physicians are delaying or altering treatment for ectopic (tubal) pregnancy (https://www.washingtonpost.com/health/2022/07/16/abortion-miscarriage-ectopic-pregnancy-care/?pwapi_token=eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJzdWJpZCI6IjMzMjkyOTg1Ii),  infections (https://www.npr.org/sections/health-shots/2022/07/26/1111280165/because-of-texas-abortion-law-her-wanted-pregnancy-became-a-medical-nightmare), miscarriages (https://apnews.com/article/abortion-science-health-medication-lupus-e4042947e4cc0c45e38837d394199033), lethal fetal conditions (https://www.wafb.com/2022/08/15/mother-claims-she-was-denied-an-abortion-despite-babys-condition/), maternal cancer (https://www.nbcnews.com/news/latino/mom-abortion-ban-daughter-death-dominican-republic-rcna43600) or other life threatening maternal conditions (https://www.nytimes.com/2022/08/01/us/abortion-journey-crossing-states.html). It is difficult to predict how this will affect any specific patient because (a) health care personnel may be reluctant to talk about their changing practice patterns, (b) the Dobbs decision is recent and behavioral changes are still ongoing, (c) research studies typically take years to publish. However, it seems likely that care will often be delayed and occasionally altered as health care personnel grapple with their fear of prosecution.

I suspect that, over time, to minimize the risk of prosecution, some health care personnel in these anti-abortion states will presume all women and girls to be pregnant unless proven otherwise and that they will administer pregnancy tests more commonly before starting or continuing treatments that may be dangerous to the unborn. These treatments include immunosuppressive drugs for autoimmune diseases (rheumatoid arthritis, lupus, multiple sclerosis), cancer treatments (radiation, chemotherapy, other drugs), as well as drugs for more common diseases (acne, bacterial infections, coagulation disorders, high blood pressure, manic-depressive disorder, seizures, see https://www.rxlist.com/teratogenic_drugs/definition.htm, https://www.ncbi.nlm.nih.gov/books/NBK553086/).  Some physicians may refuse to treat women or girls for these conditions unless it is clear that they cannot become pregnant in the future because they want to eliminate even the possibility of treatment being given during pregnancy and they cannot test every day.

What do you think? I welcome your opinion on how these state anti-abortion laws may affect medical care to women and girls, pregnant or not.