A Year Later, Doctors Feel Impact of Dobbs Decision 'Every Single Day'

It's been one year since the Supreme Court overruled Roe v. Wade, the landmark case that enshrined federal abortion protections for nearly 50 years.

Within days of the 6-3 ruling on Dobbs v. Jackson Women's Health Organization, 13 states' trigger laws criminalizing abortion took effect, and in the year since, more than half of U.S. states have abortion restrictions or bans. Abortion access is now a patchwork where accessing or providing care can depend on where you live and if you have the privilege and financial means to travel. Doctors and patients across the country are feeling the direct impacts of this disparity.

Insufficient Patient Care

Melissa Simon, MD, an ob/gyn at Northwestern Medicine in Chicago and director of the Center for Health Equity Transformation, practices medicine in a state that still protects abortion access. But she's seen patients who have fled their home states to access abortion.

One particular patient story has stuck with Simon: that of a young adult patient who traveled from Alabama with her mother to access abortion care in Illinois after experiencing rupture of the membranes at an early gestational age.

"No healthcare provider was going to be able to do anything in Alabama and waiting for something to happen is really dangerous for the mother. So they came to Chicago to get an abortion procedure because there was no chance that this pregnancy was going to survive and that this baby was going to survive," Simon told MedPage Today. "There was a high chance that the mother would develop an infection or could die in that scenario."

Even though the pregnant patient in this situation wanted to keep the baby, it was medically impossible.

"Considering abortion or terminating a pregnancy is a decision that is never taken lightly by the person who's pregnant," said Simon. "So this decision -- the overturning of Roe v. Wade -- is one that weighs on all of us. People who can get pregnant, women, and healthcare providers. It weighs on all of us every single day."

Simon's patient's story aligns with scenarios outlined by a preliminary report from the University of California San Francisco's Advancing New Standards in Reproductive Health (ANSIRH) on how post-Roe laws are leading to worse clinical care and patient outcomes.

From September 2022 to March 2023, providers anonymously submitted 50 stories of insufficient patient care as a result of new laws. The narratives fell into categories including obstetric complications in the second trimester, ectopic pregnancy, underlying medical conditions that made continuing a pregnancy dangerous, and delays obtaining abortions and abortion-related care.

UCSF ob/gyn Daniel Grossman, MD, who is also the director of ANSIRH, said that while the report details short-term complications stemming from abortion bans, the laws will have longer term effects.

"This is going to increase maternal mortality, pregnancy-related mortality, and exacerbate the disparities that we see in maternal mortality in this country," Grossman told MedPage Today.

Earlier this year, the CDC reported that maternal mortality in the U.S. rose significantly in 2021, with the impact felt most among Black women. Simon noted that maternal mortality rates are not done rising -- "and that's really scary."

Simon added that people in maternity deserts are feeling this burden disproportionately, as are rural women, women of color, women with low health literacy, and women who don't speak English.

An Unprecedented Moral Crisis

Providers are also mentally struggling with laws that dictate the kind of care they can provide, according to the ANSIRH report.

"They're really experiencing moral distress, because they can't provide the care that they were trained to provide. They really feel like their hands are being tied," said Grossman.

David Hackney, MD, a maternal-fetal medicine doctor in the Cleveland area and professor at Case Western Reserve University, echoed that sentiment. He said providers acclimate to the stress of providing patient care, however, "we're definitely not used to criminal charges or the moral injury of being able to do something but being prevented [by] the law from doing so."

Ohio had an abortion ban for three months, but it has been under injunction since September. He said this looms over providers as a "sword of Damocles."

Rachel Weinerman, MD, an ob/gyn and reproductive endocrinologist at Case Western Reserve University in Cleveland, said she explains the current legal situation to patients every day.

"Patients are scared -- that is the most significant thing that I've noticed in my practice. Patients are scared to get pregnant in the state of Ohio because they are worried what care will be available for them when they need it," said Weinerman. "They don't necessarily know what is legal [and] what is illegal because the law has changed so many times."

Weinerman said that doctors at smaller practices have it harder because they might not have access to lawyers to help interpret laws. Even with legal clarity, practicing medicine with restrictions is taxing.

"Sometimes I feel that I am not able to fulfill the Hippocratic Oath that I took when I graduated from medical school. Because sometimes, not providing abortion care is actually doing harm," said Weinerman.

In this year's match, ob/gyn applications remained competitive yet slightly rose in states with abortion protections, though every position was filled, even in restrictive states.

Sarah McNeilly, a medical student at Albert Einstein College of Medicine in the Bronx and student leader within Medical Students for Choice, said she's noticed a groundswell of medical students willing to talk about the intersection of medicine and politics. Though the political and healthcare landscapes are daunting, she added that it's realistically what this generation of medical students is inheriting.

"More physicians are willing to wade into these conversations," she said. "I think that as a physician in training and somebody at the very beginning of my career, those sorts of changes are very exciting to me."

Doctors Find Hope

Amid the chaos and uncertainty, providers are finding ways to keep up the fight.

Simon said misinformation about abortion and reproductive healthcare is widespread, and trust in healthcare and science is low.

"The onus is on us as healthcare professionals and scientists to work hard to garner that trust again, and also to manage the rampant disinformation that is really being promulgated across the internet especially," said Simon.

Grossman noted that his colleagues who aren't ob/gyns have been more vocal about reproductive health and how it intersects with other fields of medicine in the last year, a sentiment echoed by other ob/gyns.

Hackney said that while people across the country are facing different circumstances than they were pre-Dobbs, "I think it is important to remember that everyone's in the same boat and ultimately rowing in the same direction. Just because you have 50 different stories doesn't mean that we're now on 50 different teams."

Weinerman added that across the country, ob/gyns are advocating for what's best for patients.

"What gives me hope is that if people are loud enough, their voices will be heard," she said.

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