Restrictions on reproductive rights hurt everyone

On the cusp of the anniversary of the Supreme Court leak that foretold the ruling in Dobbs v. Jackson Women’s Health Organization, we face another threat to reproductive care. The Food and Drug Administration’s (FDA) approval of mifepristone, a safe and effective medication used for decades to terminate pregnancy in the first 10 weeks, is in jeopardy based on the ruling of a single judge. On April 7th, a federal judge in Texas suspended FDA approval of mifepristone. That same day, a federal judge in Washington issued an order barring the FDA from rescinding its approval. Although the Supreme Court issued a temporary stay, millions of women and people who can become pregnant face uncertainty as to whether a safe and effective treatment option, available for decades and used by many, will suddenly be taken away from them. 

As a board-certified obstetrician-gynecologist (OB/GYN), I’ve learned that keeping up with the ever-shifting landscape of regulations is part of the job. Setting aside the politics of the day, the fact remains that for decades, women and people who can become pregnant have relied on mifepristone as an option in planning their lives. But this is no longer a “woman’s issue.” The recent district court order from Texas to revoke FDA approval of mifepristone is yet another interference in the provider-patient relationship that compromises the overall quality of health care for everyone in this country. Within the first six months following the Dobbs decision last June, 24 states passed either near-total bans on abortion or banned it entirely at early stages in a pregnancy. In some cases, the courts blocked these bans from taking effect, but that has left health care providers and their patients in a murky situation. Many providers don’t even know if they can legally perform a procedure that’s medically appropriate and chosen by their patients. While abortion bans remain up in the air, the threat of losing a medical license, facing fines or prison limit many providers’ and patients’ choices.  This uncertainty is untenable in the context of a condition with a deadline measured in weeks. But it doesn’t stop there: When legislators practice unlicensed medicine, hastily drafted laws endanger other reproductive services such as IUDs, Plan B (emergency contraception), or fertility treatments.

TheDobbs decision came at a time when access to health care for women was already in jeopardy. For example, health care access is especially challenging for women in rural areas, with these “health care deserts” only expanding. In 2020, before Dobbs, 47 percent of rural community hospitals did not provide obstetric services. (Obstetric care covers the stages from conception, pregnancy, childbirth and postpartum care.) In 2021, the New York Times reported that this trend is accelerating, and that “closure of an obstetrics unit often begins a downward health spiral in remote communities.” Earlier this year, a hospital in Idaho cited provider shortages, fewer births and the political climate for reasons why they closed their labor and delivery unit. This continuing U.S. trend is especially galling in a high-income country with one of the highest rates of maternal mortality that spiked in 2021. It is women of color, especially Black and Indigenous women, whose risks of life-threatening complications remain high.

Similarly, following Texas’s controversial 6-week abortion law (SB 8, which took effect in 2021) that restricted termination to the very early stages of pregnancy and created a right to sue anyone assisting termination for $10,000, one study of two hospitals in Dallas found that the resulting changes in state-mandated management of pregnancy complications was associated with significant maternal morbidity. In other words, in a state severely limiting abortion and placing physicians at risk of legal action, the reporting of complications was delayed, and the type of treatments provided was curtailed. This chilling effect meant patients faced an average delay of nine days to receive life-saving care.

Health advocates warn that both limits on OB/GYN training and a potential OB/GYN shortage are longer-term effects of the Dobbs ruling. JAMA Network reported on a study that looked at how training for current and future medical students will change. An estimated 45 percent of accredited U.S. obstetrics and gynecology residency programs are located in the states that ban or severely restrict abortions. For OB/GYNs who have completed their training already, working in a state with strict abortion access is less and less appealing. Ultimately, it is the communities in these rural areas that will struggle with ever-widening gaps in health care access.

Against this backdrop, the Texas judge’s ruling on mifepristone adds yet another challenge with which all women in this country — and the people who love them — must contend.  Mifepristone is by far the most common way Americans choose to safely terminate a pregnancy.  It has been used safely and effectively for two decades. Over 100 clinical studies demonstrate mifepristone’s effectiveness and safety.  Nor is this about the second and third trimesters — mifepristone is used in the first 10 weeks.  Allowing its use represents a reasonable compromise that the overwhelming majority of patients can get behind. 

The case in Texas represents a small interest group seeking to replace their judgment for that of physicians. The responsibility falls on all of us to recognize that restrictions on reproductive care affect all types of health care services.  And restrictions on physician’s ability to exercise their judgment and treat their patients serves no one but the special interests.

Dr. Mary Jacobson, fondly known as Dr. J, is the chief medical officer at Alpha Medical, a telemedicine company that aims to empower women to take control of their personal health care by providing patients with access to simple, everyday medical needs in a convenient, affordable, and discreet online process. She received her medical degree from Georgetown University School of Medicine. She is an accomplished academic, board-certified obstetrician and gynecologist with extensive experience in clinical care, medical education, hospital operations and research. She completed her residency and fellowship at the Stanford University School of Medicine.