Abortion Restrictions Threaten All Reproductive Health Care Clinicians

The Supreme Court’s decision on Dobbs v Jackson will have an impact on reproductive health care provision for years to come, not only where abortion care is now restricted but across the country. As of January 2023, 14 states have outlawed or severely restricted abortion.¹ Morbidity and mortality around the time of labor is already on the rise nationally, from 658 in 2018 to 861 in 2020²—particularly in places where abortion is restricted and labor care is increasingly sparse because of loss of the workforce after the COVID-19 pandemic.³ It is important to understand how the criminalization of abortion providers will affect all other forms of reproductive health care moving forward.

In states where abortion care is currently severely limited, clinicians who provide abortion care face criminalization that can include insurmountable legal fees, loss of their medical license, and even imprisonment. Abortion restrictions create a duality in which providers feel they must serve as agents of the state—reporting any suspicious pregnancy-related issues—or have their license called into question, all while trying to best help their patients. Since these laws took effect, we are already seeing delays in health care services for patients needing early pregnancy care management—for abortion as well as miscarriage management and ectopic pregnancies.⁴ Health care providers may be called on to increase surveillance and report signs of abortion that can violate their protection of HIPAA (the Health Insurance Portability and Accountability Act) rights, while also facing malpractice claims if they, by delaying or denying early pregnancy care management, are providing what medical evidence shows to be substandard care.⁵

Beyond losing providers to criminalization, there is the very reasonable reaction that providers may have to these laws, which is to leave their communities and instead provide care in less restrictive states. Many providers are not willing to face the moral injury of restrictive laws preventing them from providing comprehensive, evidence-based care. There are also the potential legal fees providers in states with restrictions will ultimately face, which they may not be able to pay. Thus, some are already leaving their communities to find jobs in states where they can practice without fear or the burden of legal challenges.⁶

It is important to note that providers of abortion care are also providers of other reproductive health care, such as prenatal care, gynecologic services, and gender-affirming care. Communities providers are forced to leave will be left with diminished access to these lifesaving forms of care. This is particularly challenging in rural areas, where there are already scarce prenatal and labor care resources. There is a possibility that providers leaving these communities because of real or perceived risk of criminalization for providing abortion care will result in worse disparities in care for patients overall. This would compound already existing disparities in care in marginalized communities, such as BIPOC (Black, Indigenous, and other people of color), LGBTQI (lesbian, gay, bisexual, transgender/-sexual, queer or questioning, or intersex people), rural areas, those who are incarcerated, those who are undocumented, and those with disabilities.

This is not how health care should work. Health care decisions should be guided by science and evidence, not by politics. Patients will be harmed if providers are forced to choose between their best judgment and their medical license. Communities losing clinicians will lose access to not only abortion care but also other critical reproductive health care. We have an obligation to advocate the reversal of these abortion restrictions and the reestablishment of federal protections so that patients and their doctors can make personal health care decisions that are based in science.