In an earlier era in American history, individuals seeking elective or medically indicated termination of pregnancy were forced to turn to poorly skilled practitioners or dangerous putative abortifacients. Unqualified practitioners offered abortions in non-medical settings, often performing procedures for which they were not medically competent, or using potentially dangerous medications that require highly monitored environments. [1, 2] Alternatively, individuals attempted to self-induce abortion via ingestion of chemicals or herbal preparations, including turpentine, bleach, black cohosh root, or pennyroyal, or insertion of herbal preparations or inappropriate medications or chemicals, such as Lysol, into the vagina or uterus. [2, 3] Unsupervised surgical or medical abortions caused physical and psychological harm, severe illness, and death. [2] When the abortion is unsuccessful, abortifacients may exert a teratogenic effect on the fetus. [4].
In 1973, the US Supreme Court ruled in Roe v. Wade that pregnancy terminations could be performed by physicians without fear of prosecution. This decision effectively ended abortions by unqualified practitioners in non-medical settings and empowered physicians to prioritize maternal health. [5] Almost immediately after the Roe decision, the death rate from pregnancy terminations plummeted to 5% of its prior rate, making the legalization of abortion an important advancement in public health. [6] The patient safety benefits from this decision were dramatic and continue to this day, conferring a death rate of < 1 in 100,000 legal abortions in the USA. [7] In stark contrast, an analysis performed by the WHO identified unsafe abortion as responsible for 8% of maternal deaths in developing nations. [8].
If abortion access is restricted, efforts by patients to terminate pregnancy without the aid of qualified healthcare providers will increase. [9, 10] Lack of access to medically supervised abortion services will potentially stimulate clandestine distribution of abortion medications like mifepristone and misoprostol and counterfeit abortifacients. [11] Limitations on the use of methotrexate already complicate the management of ectopic pregnancy in the USA. [12] Additionally, imprecision in the term “abortifacient” can be used to justify further limitations on access to contraception. [13] The attendant health benefits of contraception, including reductions in unwanted and high-risk pregnancies, maternal morbidity and mortality, and unsafe abortion, have led to international acceptance that universal access to birth control is essential to human rights. [14].
We believe without reservation that healthcare should be provided by qualified medical practitioners. According to the World Health Organization (WHO), abortion services are part of comprehensive healthcare. [15] As medical toxicologists, we urge healthcare providers to act to preserve the right to obtain a safe and legal abortion throughout the USA. It is our duty to advocate for the public health and safety of our patients.
Anne-Michelle Ruha, MD.
Kavita Babu, MD.
Jennifer Carey, MD.
Andrew Stolbach, MD, MPH.
Meghan B. Spyres, MD.
Ayrn D. O’Connor, MD.
Jeffrey Brent, MD, PhD.
Sources of Funding
None.
Declarations
Conflicts of Interest
None.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
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