Acute care surgeons should prepare to treat complications of forced pregnancies and unsafe abortions following the Supreme Court’s decision to overturn Roe v. Wade in the US in 2022, argue experts in an opinion piece published in Trauma Surgery & Acute Care Open.
The decision will disproportionately affect poor women and women of color and will be harmful to their families and communities, and so “should be denounced by the profession,” they say.
States v. Abortion
Abortion in the US constitutes “essential health care,” say the authors. But the Supreme Court’s overturning of Roe v. Wade in June 2022 led to 12 states effectively banning abortion overnight, and many others planning strict legislation, including limiting abortions to six weeks after conception.
As nearly 60 percent of American women of childbearing age—around 40 million—now find themselves in states hostile to abortion, abortions outside of a formal medical setting or self-managed abortions (SMAs) are likely to increase.
The authors stress that, when conducted under safe conditions, abortion is an extremely effective and safe procedure. They point out that, unlike the pre-Roe era, abortion medication is now widely available across state lines, via mail order.
Acute care services are unlikely to be needed for complications of mail-order medical abortions, as, when prescribed by a qualified provider, they are “roughly 14 times safer than pregnancy itself.” However, they acknowledge that patients may be seeking pain management. The experts say, “it is imperative to protect the privacy of the patient and treat the medical issue at hand without allowing intrusive criminal legal systems to impose on patient care.”
Surgeons are expected to be prepared to treat complications, such as infection or hemorrhage, that may occur if pregnant women seek an unsafe SMA either by ingesting a toxic substance or self-inflicting a physical injury. Such unsafe approaches to a self-managed abortion can also result in injury to the uterus, bowel, bladder, and circulatory system.
In such cases, as per experts, there should be an “emphasis on nonjudgemental treatment,” and providers have the ethical duty to protect patient privacy, and “to not report these complications” to law enforcement in states where abortion is prohibited.
As pregnancy is riskier than legal abortion and given the high maternal mortality rate in the US, acute care surgeons will likely face patients with complications resulting from forced pregnancy, such as hemorrhage, eclampsia, obstructed labor, and sepsis.
The experts also argue that the increase in forced pregnancy following the Dobbs decision will further marginalize women who are more likely to seek abortion services and trauma care, as those denied abortion are more likely to go on to live in poverty.
Women with a history of intimate partner violence will also be disproportionately impacted, as they experience higher rates of unintended pregnancy. Previous studies have shown a “dramatic increase in maternal mortality in states where abortion is restricted” that has disproportionately affected Black and Indigenous patients. So the prohibitive legislation “will lead to increased death of pregnant patients from external violence as well as from physical complications of forced violence.”
The authors also warn against a possible “brain drain” in obstetrics and gynecology, as abortion bans impact technical training not only for abortion treatment but also for miscarriages and other aspects of pregnancy care, further worsening reproductive care for women.
They say, “all physicians, including trauma and acute care surgeons, play a role in the care of people who can become pregnant, and all physicians will be impacted by the consequences of this ruling. As medical providers and responsible citizens of a society that fails to equitably care for its most vulnerable, we must act to prevent harm both, in our medical practice and with our voices.”
- This press release was provided by the British Medical Journal