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The domino effect of overturning Roe goes well beyond abortion

Protesters for abortion rights demonstrate outside the Supreme Court on Friday, June 24, 2022 after the court released a decision to strike Roe v. Wade.

The ripple effects of the U.S. Supreme Court’s move to overturn Roe v. Wade are still being understood as the availability of abortion-related services diminishes rapidly across the country. One of many potential consequences of the court’s decision involves the health of all women, pregnant or not, who reside in nearly half the states that have either banned or significantly limited abortion rights or have similar laws in motion.  

Will an increasing number of medical professionals choose to work in pro-choice states, and cause a decline in the accessibility of medical authorities in states where abortion rights are restricted? As OB-GYNs consider moving across state lines, what impact would their departure have on the availability of general women’s health care in the communities they leave behind? 

Physicians overwhelmingly support unrestricted access to abortion counseling and services. A recent survey of nearly 1,000 doctors by the University of Wisconsin-Madison’s Collaborative for Reproductive Equity puts the statistic at approximately 80 percent. A vast number of them expressed concern “that abortion laws will make it difficult for physicians to offer timely and appropriate care (93 percent) and for patients to receive the care they need (91 percent).”  

Doctors and nurses are in the business of providing care — and if they’re barred from being able to even speak with patients about abortion, it’s hard to imagine they would want to work in a state that limits their ability to practice. 

There are now a whole host of new considerations for health professionals in deciding where to work or train. Experts are debating the possibility that physicians in abortion-banned states could be held criminally responsible for even discussing abortion with patients, or making referrals to out-of-state providers. All medical professionals will be evaluating whether it makes sense to start or continue their careers in areas when there’s a potential risk of jail time for the simple act of addressing a patient’s medical needs.  

Another concern for physicians is the unavoidable conflict many will face when choosing between the life of a pregnant mother or her unborn child in emergency situations. Doctors have a sworn responsibility as part of their Hippocratic Oath to “do no harm” to their patients — yet in abortion-banned states, they could be legally compelled to save the child in every situation, regardless of the family’s wishes. Physicians will have to decide whether they want to work in states where their work is defined by the law instead of medical best practices.   

Then there’s the issue of accreditation. Today, roughly 45 percent of the country’s nearly 300 OB-GYN residency programs exist in states that have either banned abortion or are likely to do so in the wake of the Supreme Court’s decision. Yet the standards-setting Accreditation Council for Graduate Medical Education (ACGME) requires all OB-GYN residency programs to provide access to abortion training. Students can object and opt out based on moral or religious reasons, but the training must be available, and residents are required to know how to discuss the procedure and the potential associated complications.  

This means nearly half of the residency programs in America are now at risk of not meeting their accreditation requirements. They will be unable to provide the necessary training for OB-GYN residents who want to learn how to counsel, support or perform these procedures for patients who seek such services. This could encourage many future OB-GYNs to do their residencies in pro-choice states. And this would further decrease OB-GYN availability in states where abortion is illegal since the majority of medical students often stay and start their careers in the same states where they complete their residencies.  

The disproportionate effects on women of color in abortion-banned states have been rightly pointed out in the wake of Roe v. Wade’s overturn. Women who lack financial resources will be adversely impacted, too.  At a time when the American Association of Medical Colleges (AAMC) predicts a shortage of up to 140,000 physicians in the U.S. by 2033, any reduction in OB-GYNs and other medical professionals in half the nation’s states will further compound an already worrisome problem. 

Roe v. Wade’s overturn may seem to some as just a states-rights issue. But for millions of women in America, expecting or not, it has the potential to disrupt the balance of health care service accessibility across the nation. For them, the long-term public health consequences mean something profoundly different. And there’s no solution in sight. 

Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.