The overturning of Roe v Wade places physicians in some states in a tough situation: Do what's best for patients or risk losing your medical license.

Abortion is now illegal in multiple states unless the patient faces "a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy."

Tracking the states where abortion is now banned. The New York Times. August 26, 2022.

But there are still safe ways physicians can provide the best care to pregnant patients without putting themselves at legal risk.

Klibanoff E. Texans who perform abortions now face up to life in prison, $100,000 fine. The Texas Tribune. August 25, 2022.

 

 

The consequences of not providing care

It’s nearly impossible to flip through a medical journal or scroll through social media without hearing about this ruling and how it’s affected physicians and patients in nearly every state—including those where safe abortions are allowed.

With an increase in bans, there will be more unsafe abortions and preventable maternal morbidity and mortality, according to research. Pregnant patients who want an abortion are now at risk of financial burdens due to out-of-state travel and time off work. Many patients may engage in unsafe abortions, potentially risking their lives.

States that have restricted or banned abortion may see fewer abortions. However, other states where abortions are still accessible may compensate, possibly resulting in the same number of abortions overall while exhausting HCPs in those states.

Research shows that banning abortion does not reduce the number of abortions occurring annually; rather, doing so results in a greater number of unsafe abortions performed.

Barack J, Popinchalk A, Ganatra B, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Health. 2020;8(9):e1152–e1161.

Additional research indicated that 25% of American women are expected to get an abortion during their lifetime, and nearly 630,000 abortions were documented in the US in 2019.

 

Planned Parenthood reported a nearly 800% increase in Texans seeking abortion care in surrounding states during the short life of the Texas Heartbeat Act, which banned abortion after the detection of fetal cardiac activity.

 

Providing care without risking your license

Providing care in these states doesn’t necessarily mean breaking the law by performing an abortion. It can mean providing emotional support to patients and providing them with the many resources available to help them obtain the care they need.

These options include seeking abortions in other states, as well as obtaining abortion pills before pregnancy occurs.

 

Out-of-state abortions

If a patient has the means (transportation, money, time off work, etc.), an abortion in a state where abortions are legal is the best option—but these states are bracing for a likely flood of patients traveling from trigger states to get an abortion.

Clinics and HCPs in these states are therefore stretched thin. Waiting times can be so far out that patients may miss the window for second-trimester abortions. So some states are working to change their laws to allow mid-level HCPs, such as nurses and midwives, to provide abortions.

Some believe that allowing non-physicians to handle simple, very early abortions that involve prescribing a pill could free up more physicians to handle complicated procedures that usually occur late in pregnancy or complications from recent abortions.

Laws have been enacted in Connecticut, Maryland, Washington, and Delaware to allow non-physician clinicians to perform certain uncomplicated, early-term abortions.

Haigh S. With Roe in doubt, states weigh letting nurses do abortions. Abc10.com. Updated June 1, 2022.

In addition, lawmakers in California are considering a bill that would update a 2013 law that allows nurse practitioners to perform abortions without the supervision of a doctor, as currently required.

California can improve access to abortion by easing rules on physician oversight. CalMatters. August 12, 2022.

 

 

Abortion pills before pregnancy

Plan C is a website that provides resources to pregnant individuals, but doesn’t give medical or legal advice or provide abortion pills. Instead, the site partners with the following organizations that can direct pregnant individuals to the help they need.

• The M+A (Miscarriage + Abortion) Hotline is a free, confidential service where patients can connect with doctors. (M+A does not sell abortion pills.)

• Reprocare Healthline, where patients can speak with a peer counselor or doula for free information on how to get (and use) abortion pills.

• The Repro Legal Helpline provides free, confidential legal information.

They can then take the pills immediately. Some services listed in The Plan C Guide to Abortion Pill Access allow individuals to order pills in advance.

Aid Access offers this "advance provision" in all states. The site will also help with instructions and follow-up support. And Plan C allows patients to access resources specific to their state—even in those that have banned abortions.

How to get abortion pill access in Tennessee. Plan C.