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The Dartmouth
May 22, 2024 | Latest Issue
The Dartmouth

Yang, Greene and Matsunaga: Defining an Emergency Post-Roe

The downstream consequences of restricting access to abortion show why abortion access must be protected.

In the wake of Dobbs v. Jackson Women’s Health Organization — the U.S. Supreme Court decision that overturned Roe v. Wade — many are left wondering how to support doctors and clinics in states where abortion is now illegal. Our obstetrics and gynecology professors at Geisel School of Medicine suggest one idea: donate blood. As abortion access becomes increasingly sparse, doctors expect an uptick in patients with life-threatening bleeding when treating pregnancy-related complications such as ectopic pregnancy. As many people face traveling long distances to receive the care they need and providers in states where abortion is still legal become increasingly busy, we will likely see an increase in self-induced abortions without the trained help of medical providers. These procedures may increase preventable complications including excess bleeding, which would require utilizing supplies of donated blood that are already in high demand. 

Without federal protection for the right to abortion, many states have initiated strict bans with exceptions only in the case of a medical emergency. Although these laws imply there is a cut-and-dry definition of a medical emergency, in reality, this is rarely the case. 

In an ectopic pregnancy, an embryo grows outside of the uterus and is, by definition, not viable. Ectopic pregnancies occur in locations that are not capable of accomodating a growing embryo like the fallopian tubes, which are small structures meant to carry eggs from the ovaries to the uterus. Continued growth of the embryo can cause significant damage to surrounding structures, leading to complications like ruptured fallopian tubes and life-threatening internal bleeding. Typically, doctors treat ectopic pregnancies with an abortion as soon as possible, before the embryo grows too large and complications like bleeding start. However, since Dobbs, new state laws with narrow exceptions for what constitutes a permissable abortion have created confusion and distress among doctors. Abortion providers are now forced to ask questions like, is this person’s life threatened enough to make this an emergency? Should I call a lawyer before I bring this patient to surgery? If I treat them, will I lose my license?

As medical students taking early steps into this profession, it is distressing to hear about the rippling ramifications of overturning Roe. Providing miscarriage care and treating dangerous infections in the uterus can draw legal scrutiny that threatens doctors’ livelihoods in states where abortion is now virtually illegal. Additionally, many medications that can be used in abortions, like methotrexate, are also used to treat other medical conditions like rheumatoid arthritis and lupus. Undue scrutiny on prescribing these medications not only impacts access to abortion care but has detrimental effects on people with these chronic conditions, a majority of whom are reproductive-aged females. The effects of dwindling abortion access will also disproportionately affect marginalized communities, such as people of color and those of low socioeconomic status. 

According to the CDC, in 2019 more than half of abortions were among people of color, a population with greater barriers to healthcare access overall. These barriers are multifaceted, including being more likely to be covered by public health insurance like Medicaid, which offers only limited abortion care under the Hyde Amendment, fewer financial resources and ability to travel for care, as well as racism and discrimination in interactions with the healthcare system. It is also crucial to point out that pregnancy itself is not at all benign, especially in the United States where maternal mortality has actually increased in recent years. Additionally, pregnancy-related mortality is higher among Black and American Indian/Alaska Native populations compared to white populations, and further restricting access to abortions will likely increase these preexisting health disparities. Practicing medicine in states where abortion is outlawed requires physicians to decide what qualifies as an emergency in order to provide necessary care. In the United States, where childbirth actually carries a higher risk of death than a legal abortion, carrying a pregnancy to term could be considered an emergency. Forcing physicians to make impossible choices in the face of legal scrutiny will likely mean that pregnant patients will receive substandard care as their doctors’ attempt to steer clear of legal gray areas. It will also mean that many current and future doctors will shy away from front-line specialties where they may face such situations.

In 2021, New Hampshire implemented the first abortion restriction in state history by banning abortion after 24 weeks. While abortion before 24 weeks gestation is currently safe and legal, the loss of constitutional protection for abortion means this right is not guaranteed. It is not unreasonable to imagine that state legislators will propose more restrictive abortion laws in the future, which could result in numerous consequences outside of abortion. Now more than ever, it is critical for Granite Staters to elect state legislators who promise to protect reproductive rights in New Hampshire. And while we continue to fight for our right to essential healthcare like abortions, consider donating blood as a way to care for those who experience complications as a direct result of anti-choice legislation.

Ashley Yang, Lily Greene and Sarah Matsunaga are students at the Geisel School of Medicine graduating in 2024. This column was written with the assistance of Katie Allan Med’24, Carly Ratekin Med’24, Maggie Sherin Med’24 and Delaney Taylor Med’24. The views and opinions expressed here are not necessarily those of Geisel, and they may not be used for advertising or product endorsement purposes.

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