Abortion and reproductive healthcare
Following the U.S. Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization overturning the long-standing precedent of Roe v. Wade, 25 states have restricted or banned access to abortion.[i] The criminalization of providing abortion and reproductive healthcare has forced a broad array of health professionals to the frontlines of a political debate for simply doing their jobs and providing essential care. This politically motivated intrusion into the relationship between a patient and their care team interferes with health professionals’ responsibility to provide the best care available. Not only do these restrictions infringe on a patient’s right to self-determination, but they also put access to all reproductive and maternal care at risk, endangering pregnant patients, women, families and the health professionals serving them.
The consequences of abortion bans and restrictions extend far beyond limiting access to one procedure. Facing the possibility of endangering their license or facing criminal charges for providing medically necessary care, health professionals are making difficult decisions about where to practice. In 2023, applications for OB/GYN residency in states with abortion bans or restrictions decreased by more than 10 percent.[ii] Nearly half of rural hospitals already lack labor and delivery services;[iii] and in March 2023, a rural hospital in Idaho closed its labor and delivery services, citing problems retaining OB/GYN and pediatric physicians due to the state’s abortion restrictions.[iv]
Even with services intact, patients may delay or forgo care because they fear their privacy will be violated, potentially resulting in criminalization. In a December 2022 survey by Data for Progress, 6 percent of respondents who sought reproductive healthcare in the last year said they withheld some information from their provider because they did not feel confident that it would be kept confidential. Notably, patients from groups historically impacted by criminalization were more likely to report withholding information for this reason, with 10 percent of Black respondents and 13 percent of Latina respondents reporting withholding information about reproductive health from a provider due to privacy concerns.[v]
Physicians and other professionals who train in states with bans or restrictions on abortion access may also face limited opportunity to attain competency in the full spectrum of reproductive healthcare. Having fewer providers trained in this full spectrum has serious implications for maternal and infant health, especially in communities that already face higher barriers to accessing high-quality care. Communities with less access to full spectrum reproductive healthcare experience higher rates of maternal mortality.[vi] Between 2018 and 2020 maternal death rates increased nearly twice as fast in states with abortion restrictions; and in 2020, maternal death rates were 62 percent higher in states with abortion bans and restrictions than in states where abortion access is protected.[vii]
Facing a historically high maternal mortality rate, deep racial inequities in healthcare, eroding access to healthcare in rural areas and a healthcare staffing crisis, we need solutions to expand the healthcare workforce and to expand access to care—not more politically motivated restrictions that hurt patients.
The AFT unequivocally supports the right of all health professionals to provide ethical medical care based on a patient’s well-being and not motivated by political climate, as well as the right of all patients to access the full scope of reproductive healthcare and to make their own family-planning decisions.
[i] Kaiser Family Foundation, “Status of Abortion Bans in the United States as of March 22, 2023.” https://www.kff.org/womens-health-policy/dashboard/abortion-in-the-u-s-dashboard/
[ii] American Association of Medical Colleges, “Training Location Preferences of U.S. Medical School Graduates Post Dobbs v. Jackson Women’s Health Organization Decision,” April 13, 2023. https://www.aamc.org/advocacy-policy/aamc-research-and-action-institute/training-location-preferences
[iii] New York Times, “Rural Hospitals Are Shuttering Their Maternity Units,” Feb. 26, 2023. https://www.nytimes.com/2023/02/26/health/rural-hospitals-pregnancy-childbirth.html
[iv] The Guardian, “Idaho Hospital to Stop Delivering Babies as Doctors Flee over Abortion Ban,” March 20, 2023. https://www.theguardian.com/us-news/2023/mar/20/idaho-bonner-hospital-baby-delivery-abortion-ban
[v] Data for Progress, December 2022. dfp_disability_reproductive_privacy.pdf (filesforprogress.org)
[vi] Health Affairs, “Penalizing Abortion Providers Will Have Ripple Effects Across Pregnancy Care,” May 3, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20220503.129912/
[vii] The Commonwealth Fund, “The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions,” Dec. 14, 2022. https://www.commonwealthfund.org/publications/issue-briefs/2022/dec/us-maternal-health-divide-limited-services-worse-outcomes