Implications of Dobbs v Jackson Women’s Health Organization

During its consideration of Dobbs v Jackson Women’s Health Organization, the US Supreme Court received several scientifically, medically, and ethically sound amicus briefs in strong opposition to Mississippi’s abortion ban. Among those briefs was one that stated clearly and succinctly that “abortion is a safe, common, and essential component of healthcare.” This amicus brief was submitted jointly by the nation’s leading medical professional membership organizations: the American College of Obstetricians and Gynecologists, the American Medical Association, the American Association of Public Health Physicians, the American Academy of Family Physicians, the American Academy of Nursing, and the American Academy of Pediatrics.¹ The abundance of compelling evidence notwithstanding, on June 24, 2022, the Supreme Court issued its ruling in Dobbs, overturning 50 years of a federally protected right to abortion services while simultaneously telegraphing, through a concurring opinion written by Justice Clarence Thomas, that “all of this Court’s substantive due process precedents” should be up for reconsideration.

Six months later, what are the realized and potential consequences, especially as they relate to maternal health outcomes? As of January 1, 2023, the Guttmacher Institute has categorized 26 states as having restrictive abortion policies.² Many of the abortion-restrictive states are geographically contiguous, further extending the travel distance required for residents of some states to obtain a legal abortion in another state.² This also has the potential to create regions in the country where health care providers are unable to learn basic skills in providing abortion care, which can have ripple effects on the workforce and quality of abortion care nationally.

A recent analysis identified differences in maternal and neonatal outcomes by state abortion policy category.³ Compared with the District of Columbia and the 24 states where abortion is more accessible,^2,3 states with restrictive policies had fewer maternity health care resources, higher maternal mortality rates, and higher infant and perinatal mortality rates.³ Taken together, these results highlight a troubling reality: the very same states in which legislators have passed sweeping abortion restrictions concurrently have a terrible track record of promoting health and protecting against preventable maternal, neonate, and older infant deaths. And although such adverse consequences continue to be disproportionately experienced by people of color in both abortion-restricted and abortion-accessible states, when the authors applied the Commonwealth Fund health equity health system performance scorecard, they found more equitable outcomes in abortion-accessible states.³

Evidence continues to demonstrate that access to abortion services is an important tool for promoting maternal health. A recent study of women with pregnancy complications before 22 weeks’ gestation found that 57% who underwent state-mandated expectant management experienced a serious maternal morbidity, compared with 33% who chose an abortion under similar clinical circumstances in states without such a mandate.⁴ As this study shows, such policy approaches do not improve maternal health but may actually worsen it. To better protect pregnant individuals and children, states have an urgent need to repeal abortion restrictions. But that is not enough. They must also direct increased resources to improving maternal and child care and to eliminating inequities in access and outcomes.

Although these policies play out on a state-by-state basis, at the federal level, even after the Dobbs decision, Congress has not yet managed to pass either the Women’s Health Protection Act⁵ or the Equal Access to Abortion Coverage in Health Insurance Act.⁶

I have focused on the potential impact of the Dobbs decision on maternal and neonatal outcomes; however, I must circle back to the ominous concurring opinion of Justice Thomas. The 117th Congress partially took him at his word—and it passed, and President Biden signed, the Respect for Marriage Act, which protects same-sex marriage and interracial marriage.^7,8 Nevertheless, the assaults on abortion care via state legislation and regulation continue,⁹ as do the assaults on gender-affirming care.¹⁰

“Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy.”^11(p1) Protecting the full scope of sexual and reproductive health and rights, and doing so in a manner that accelerates and ensures equity and justice, are imperative components of what we, as a society, must do collectively.