The Supreme Court’s Dobbs vs Jackson Women’s Health Organization decision was widely anticipated and the badness that ensued was immediate.

Conservative states rushed to pass laws to restrict or ban abortion. “Trigger” laws outlawing abortion but on-hold went into effect. The list of states with total abortion bans grows and the restrictions in others become more stringent. While the Dobbs ruling ostensibly relegated abortion decisions to the states, Republicans in both the Senate (Graham) and House (Stefanik) quickly introduced legislation for federal limitations on abortion. There are attempts to resurrect the 1873 Comstock Act, which lay dormant for decades. This federal law prohibits mailing anything which can cause an “illegal abortion.”

Twenty-five million women of childbearing age now live in states where there is little or no ability to end unwanted pregnancies. The more affluent may flee to less restrictive states. The poor are left behind. People of all strata in society negotiate a confusing web of legal, quasi-legal and illegal solutions to end pregnancies. It is not the same as “before Roe”–it is worse. There are more options to end pregnancies (e.g. vacuum aspiration and medications) but there is more government interference and surveillance.

As predicted, doctors rarely defy the new restrictions. Instead, they practice substandard medical care, even committing malpractice, to avoid running afoul of the law. They are unwilling to openly discuss the tragedies they witness (and perhaps participate in) but when given the opportunity to voice their concerns anonymously they are more forthcoming. They see unnecessary complications in routine pregnancies, non-viable pregnancies carried to term, and profound suffering. Clinics providing abortions close or move to other states. Reproductive health training is up-ended. Obstetric residents from restrictive states must travel to other states to complete their education.

Again, as predicted, abortion related litigation explodes. Patients sue Texas, Texas sues Planned Parenthood, an ex-husband sues his ex-wife’s friends. a federal judge challenges the legitimacy of the FDA. Judges in some states order stays of new anti-abortion laws while in others they allow these laws to take effect.

The backlash to Dobbs was also predicted. Six states try with referendums to prevent their states’ constitutions from protecting abortion rights. In all instances, the voters favor abortion rights. The Republican party’s poor performance in the 2022 election cycle is at least partially attributable to this backlash.

Even Congress’s defense allocation and the routine promotion of officers in the military are ensnared in this issue.

Fortunately, many progressive state legislatures respond to the crisis. In New York a package of bills protecting abortion providers becomes law anticipating the Dobbs decision (which comes 11 days later). Even more remarkably, five states (including New York) pass shield laws allowing health care professionals to provide services to patients remotely (including sending them pills for medication abortion) without patients having to travel to these more progressive states. A handful of medical professionals step up to the plate to serve the patients most in need. Thousands (3,500 as of July 23) are helped. My hat is off to these courageous individuals.

— — —

Michael C. Sinclair, MD, lives in Vermontville.

— — —

Sources:

1. Vema, N and Grossman, D. Obstacles to Care Mount 1 year after Dobbs Decision. JAMA, July 11, 2023, Vol 330, No 2, 119-120. 2. https://www.politico.com/news/2022/09/13/grahams-abortion-ban-senate-gop-00056423 3. https://www.adirondackdailyenterprise.com/news/local-news/2022/09/rep-elise-stefanik-supports-15-week-abortion-ban/

4. The New Threat to Abortion Access in the United States–The Comstock Act. Cohen, IG et at. JAMA, August 3, 2023, Vol 330, No 5, 405-406.

5. https://apnews.com/article/abortion-dobbs-anniversary-state-laws-51c2a83899f133556e715342abfcface#:~:text=More%20than%2025%20million%20women,on%20hold%20pending%20court%20challenges. 6. https://www.newyorker.com/magazine/2022/07/04/we-are-not-going-back-to-the-time-before-roe-we-are-going-somewhere-worse 7. https://www.healthaffairs.org/do/10.1377/forefront.20230803.340506 8. https://womensmediacenter.com/news-features/one-year-after-the-fall-of-roe-dobbs-ruling-has-lowered-standards-of-care-increased-health-risks 9. https://www.ansirh.org/sites/default/files/2023-05/Care%20Post-Roe%20Preliminary%20Findings.pdf

10. https://jamanetwork.com/journals/jama/fullarticle/2806624 11. https://www.axios.com/2023/06/21/obgyn-training-programs-try-to-adjust-to-post-dobbs-reality 12. https://www.brennancenter.org/our-work/analysis-opinion/3-takeaways-about-abortion-litigation-dobbs

13. Gluck, AR. The Mifepristone Case and the Legitimacy of the FDA. JAMA, June 27, 2023, Vol 329, No 24, 221-222. 14. https://ohiocapitaljournal.com/2022/11/19/abortion-rights-referendums-are-winning-with-state-by-state-battles-over-rights-replacing-national-debate/ 15. https://www.nytimes.com/2023/03/31/us/military-abortion-promotions-blocked.html

16. https://www.ny.gov/abortion-new-york-state-know-your-rights/protecting-strengthening-abortion-rights 17. https://www.nytimes.com/2023/06/20/health/abortion-shield-law-new-york.html

18. https://www.theguardian.com/world/2023/jul/23/shield-laws-provide-abortion-care-aid-access