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By guest contributors Arghavan Salles, MD, PhD; Morgan S. Levy, BS; and Vineet Arora, MD, MAAP
In recent weeks, the Supreme Court of the United States heard arguments for laws restricting access to abortion in Texas and Mississippi. The country’s doctors have been surprisingly silent. When we took the Hippocratic oath, a vow to protect our patients, we said, “I will apply, for the benefit of the sick, all measures that are required.” There was no clause that said, “except when it comes to abortion.”
The Mississippi law in question bans all abortions after 15 weeks of pregnancy, “except in a medical emergency or in the case of a severe fetal abnormality“. The law does not allow exemptions in cases of rape or incest and is the most direct challenge to Roe v. Wade in 30 years. The Texas law, SB8, first went into effect in September, 2021, outlawing abortion for anyone more than 6 weeks pregnant–early enough that many people may not yet know they are pregnant. Similar to the Mississippi law, SB8 does not make exceptions for situations such as incest or rape. A novel and critical aspect of this bill is that it empowers regular citizens to go after abortion providers, a strategy many have recognized as ‘vigilante’ justice.
In recent months, there has been widespread outrage, and media outlets have published articles on how state legislators were attacking the precedent set by Roe v Wade. This type of legislation was all but inevitable after the confirmation of Justice Amy Coney Barrett, which secured the reign of the most conservative Supreme Court since the 1930s.
As physicians, we assert that abortion is, fundamentally, medical care. It is also common; approximately one in four people with uteruses has an abortion by the age of 45. So while legislators in Texas, Mississippi, and elsewhere challenge the ability of pregnant people to make decisions about their own bodies, it is incumbent upon all healthcare workers to speak up on behalf of our patients. Historically, abortion providers have been incredibly vocal in leading this fight. But the responsibility should not fall on their shoulders alone.
We have been heartened to see medical societies such as the American College of Physicians and the American Medical Association quickly decry SB8. Not only is abortion healthcare our patients need, it is also healthcare we need. In our own data, which are currently under review at a medical journal, over 1 in 10 physicians have had an abortion. If we are going to have comprehensive reproductive care for trainees and practicing clinicians, as we have argued we should, then abortion must be part of that care. The only way we can ensure access is by speaking up, loudly and clearly.
It doesn’t take medical expertise to know restricting access to abortion is harmful. Anyone who has watched the movie Dirty Dancing or shows such as Law & Order knows pregnant people will suffer under these laws. They will find other ways to end pregnancies. The number of abortions is unlikely to decrease; the number of safe abortions surely will. According to the Guttmacher Institute, the countries with the most restrictive abortion laws have the highest rates of unsafe abortions, with approximately 25 million unsafe abortions being performed globally each year.
If the regulation of abortion reverts back to the states, which is what Justice Kavanaugh implied would be a return to “neutrality,” privileged people will travel to other states to receive the care they need. This is exactly what has happened after the passing of SB8 in Texas, with both adjacent and non-adjacent states providing abortion care for Texans. Those who will be most severely affected by these laws are those with fewer resources, a group among whom Black, Indigenous, and People of Color are disproportionately represented.
To be sure, some healthcare workers believe abortion to be a political issue and do not think it is their responsibility to interfere. We argue, however, that abortion is, first and foremost, a medical issue. If we want to provide optimal care for our patients, including our colleagues, then we must ensure access to abortion.
Although Mississippi’s law, first passed in 2018, and SB8 are the most recent major attacks on access to abortion, they are unlikely to be the last. Our request is simple and consistent with this commonly used rallying cry: “When abortion rights are under attack, what do we do? Stand up, fight back!” What might this look like? Contact your members of Congress. Voice clear support for abortion, and consider your position on expanding the court. Don’t hide behind phrases such as “reproductive health.” Say the word: abortion. It’s time we end the stigma and recognize abortion for exactly what it is: fundamental healthcare.
Arghavan Salles, MD, PhD is a Senior Research Scholar at the Clayman Institute for Gender Research and the Special Advisor for Diversity, Equity, and Inclusion Programs at Stanford University Department of Medicine. She’s on Twitter: @arghavan_salles.
Morgan S. Levy, BS is a medical student in the MD and Master’s in Public Health program at the University of Miami Miller School of Medicine. She’s on Twitter: @MorganSLevy.
Vineet Arora, MD, MAAP is the Herbert T. Abelson Professor of Medicine and Dean of Medical Education at the Pritzker School of Medicine at University of Chicago. She’s on Twitter: @FutureDocs.