It’s been a year since the Dobbs decision overruled Roe v. Wade. How did this impact reproductive health across the nation? Here’s how the scientific story has unfolded, thus far. State of affairs Not to anyone’s surprise, a number of states quickly banned or heavily restricted abortions. This means, today, 1 in 4 women of reproductive age live where an abortion is banned or heavily restricted.
What I’m NOT seeing in the aftermath of Dobbs is an increasing emphasis on pregnancy PREVENTION - which is still almost solely women’s burden. It is long past time for a shift to equalizing that burden, especially now that, with abortion off the table, many tens of thousands of men will now find themselves to be unwitting and unwilling fathers of living children that they will now have the burden to support and provide for. It is time - long past time - for men to be organizing and agitating for safe, effective, reliable measures that prevent them from unwillingly and unwittingly becoming lifelong parents. The male reproductive and hormonal system is so much less complex than that of women. Birth control for men that blocks the production of sperm should be a research priority - and millions of men should be in the streets agitating for it - for themselves, for their wives, for their sisters, for their daughters, for their sons and brothers.
And for those who will inevitably respond that “men can’t be trusted to protect themselves and their sexual partners, or to tell the truth about it, ” I say, “Honey, what’re you doing sleeping with someone you can’t trust??”
there has also been a movement of established, board certified, OB-GYNs out of states with restrictive abortion laws into states without such laws. this has exacerbated already poor access to obstetric care - not to mention women's health care in general - in states such as Idaho, where I live, in which there have been high profile, well-publicized instances of established OB-GYNs moving out of state as a direct result of restrictive abortion laws. not surprisingly, this has also made it exceptionally difficult to recruit new OB-GYN physicians to the state. it would be interesting to see this quantified nationally.
this has obvious adverse implications to women's health. i realize abortion is a challenging and nuanced issue, but once again the bottom line hypocrisy of right wing politicians and judges who purport to be pro-life is on display by the extreme laws they enact and the decisions they make, of which Dobbs is only one example. and, as others have pointed out, this disproportionately harms women who are not affluent enough to travel out of state for care.
surely there must be a more humane way to approach this issue than the system we have now.
The law was not really about abortion, it was about women's freedom and who should make personal decisions a woman or a congressman? It's all about control of women and they use some religious stuff to back up their quest to control. Birth control is next.
As a family doctor who has emphasized women's health in my practice and included prenatal care and delivery in my practice, I don't have hard numbers but can relate this much. The past few months I have received many recruiter texts, emails and voice mail messages seeking "FP with OB including C-section privileges." This is unprecedented in my experience.
Very few family doctors now provide obstetric services and those who do their own C-sections (rather than consulting an OB) are very rare, typically in very small towns with no OB-GYN on hospital staff. These requests are all coming from states with restrictive abortion laws, and I suspect they now cannot recruit OB-GYNs who will practice there, and OB-GYNs who were there have now closed their practices to leave the state, or have retired.
More than 90% of all abortions are already done in the first trimester and a majority are medical abortions, not surgical. In my experience, the occasional woman who is beyond the first trimester had irregular cycles and didn't recognize the pregnancy, or they had a delay due to gathering the finances to pay for a surgical procedure; those abortions were done early in the second trimester by 15 - 16 weeks. Of the thousands of pregnant women I've seen, all abortions (except one) done later than that were the result of fetal abnormalities detected by testing done in wanted pregnancies, or very rarely, for serious maternal illness that jeopardized the woman's life. The exception was a teen whose pregnancy was the result of rape, not diagnosed until 15 - 16 weeks, and whose family had to collect the much higher dollar amount for a late procedure, then travel to a distant city for it to be performed at 23 weeks.
I do not know, nor have I heard rumor via the grapevine, of any clinician performing an abortion that was illegal in their state. No practitioner wants to be the "test case" whose life and finances are unpended by prosecution for such a criminal offense.
Thank you so much for this informative piece and for links to various safe ways to get abortions. It is terrifying to see this country actively become The Handmaids Tale. Thanks for contributing to the resistance with clear science.
Thereby demonstrating that if the ONLY thing you want to do is ban abortion AND you can control enough State power to tell the majority to sod off AND you don't give a flip about the consequences to society as a whole by doing so, it's fairly easy to accomplish.
Less easy to accomplish: convincing anyone outside of your bubble that doing all this makes you Morally Superior and a Good Christian. Rather the opposite, in fact, on both counts.
I still can’t wrap my ahead around how women, their health and their rights have been pushed back so far. The autonomy over our bodies that is a right was just stripped away. I am writing and voting accordingly, but in Texas it does not seem to make a dent in the perspective.
To repeat myself, here’s a law that needs to be passed.
“From the moment of conception, the sperm producer will be responsible for appropriate financial child care related support until the child is 18 years old or 22 years old under special circumstances.”
Beneath the data are hundred of stories of cruelty, confusion and lack of viable treatment. The HCWs are concerned about legality more than healthcare.
This is a well written column with an important and powerful message. When you wrote about covid I could share these columns with my neighbors by sending a link but this no longer seems to be possible. I hope that I am wrong -- your column is too important to be hidden behind a paywall!
thanks karen! great points! i agree wholeheartedly. it really is a human rights issue when you get right down to it, and that is a great way to frame the issue.
The one year (scientific) story of the fall of Roe v. Wade
What I’m NOT seeing in the aftermath of Dobbs is an increasing emphasis on pregnancy PREVENTION - which is still almost solely women’s burden. It is long past time for a shift to equalizing that burden, especially now that, with abortion off the table, many tens of thousands of men will now find themselves to be unwitting and unwilling fathers of living children that they will now have the burden to support and provide for. It is time - long past time - for men to be organizing and agitating for safe, effective, reliable measures that prevent them from unwillingly and unwittingly becoming lifelong parents. The male reproductive and hormonal system is so much less complex than that of women. Birth control for men that blocks the production of sperm should be a research priority - and millions of men should be in the streets agitating for it - for themselves, for their wives, for their sisters, for their daughters, for their sons and brothers.
And for those who will inevitably respond that “men can’t be trusted to protect themselves and their sexual partners, or to tell the truth about it, ” I say, “Honey, what’re you doing sleeping with someone you can’t trust??”
there has also been a movement of established, board certified, OB-GYNs out of states with restrictive abortion laws into states without such laws. this has exacerbated already poor access to obstetric care - not to mention women's health care in general - in states such as Idaho, where I live, in which there have been high profile, well-publicized instances of established OB-GYNs moving out of state as a direct result of restrictive abortion laws. not surprisingly, this has also made it exceptionally difficult to recruit new OB-GYN physicians to the state. it would be interesting to see this quantified nationally.
this has obvious adverse implications to women's health. i realize abortion is a challenging and nuanced issue, but once again the bottom line hypocrisy of right wing politicians and judges who purport to be pro-life is on display by the extreme laws they enact and the decisions they make, of which Dobbs is only one example. and, as others have pointed out, this disproportionately harms women who are not affluent enough to travel out of state for care.
surely there must be a more humane way to approach this issue than the system we have now.
The law was not really about abortion, it was about women's freedom and who should make personal decisions a woman or a congressman? It's all about control of women and they use some religious stuff to back up their quest to control. Birth control is next.
This analysis offers a stark contrast between the outcomes of theocratic decision-making and those of rational, data-driven decision-making.
As a family doctor who has emphasized women's health in my practice and included prenatal care and delivery in my practice, I don't have hard numbers but can relate this much. The past few months I have received many recruiter texts, emails and voice mail messages seeking "FP with OB including C-section privileges." This is unprecedented in my experience.
Very few family doctors now provide obstetric services and those who do their own C-sections (rather than consulting an OB) are very rare, typically in very small towns with no OB-GYN on hospital staff. These requests are all coming from states with restrictive abortion laws, and I suspect they now cannot recruit OB-GYNs who will practice there, and OB-GYNs who were there have now closed their practices to leave the state, or have retired.
More than 90% of all abortions are already done in the first trimester and a majority are medical abortions, not surgical. In my experience, the occasional woman who is beyond the first trimester had irregular cycles and didn't recognize the pregnancy, or they had a delay due to gathering the finances to pay for a surgical procedure; those abortions were done early in the second trimester by 15 - 16 weeks. Of the thousands of pregnant women I've seen, all abortions (except one) done later than that were the result of fetal abnormalities detected by testing done in wanted pregnancies, or very rarely, for serious maternal illness that jeopardized the woman's life. The exception was a teen whose pregnancy was the result of rape, not diagnosed until 15 - 16 weeks, and whose family had to collect the much higher dollar amount for a late procedure, then travel to a distant city for it to be performed at 23 weeks.
I do not know, nor have I heard rumor via the grapevine, of any clinician performing an abortion that was illegal in their state. No practitioner wants to be the "test case" whose life and finances are unpended by prosecution for such a criminal offense.
Thank you. This is another in your series of excellent columns.
Thank you so much for this informative piece and for links to various safe ways to get abortions. It is terrifying to see this country actively become The Handmaids Tale. Thanks for contributing to the resistance with clear science.
Thereby demonstrating that if the ONLY thing you want to do is ban abortion AND you can control enough State power to tell the majority to sod off AND you don't give a flip about the consequences to society as a whole by doing so, it's fairly easy to accomplish.
Less easy to accomplish: convincing anyone outside of your bubble that doing all this makes you Morally Superior and a Good Christian. Rather the opposite, in fact, on both counts.
I still can’t wrap my ahead around how women, their health and their rights have been pushed back so far. The autonomy over our bodies that is a right was just stripped away. I am writing and voting accordingly, but in Texas it does not seem to make a dent in the perspective.
Thanks so much for this (upsetting) information. I so appreciate your work. Would love your thougths on this column in yesterday's NYT: https://www.nytimes.com/2023/06/21/opinion/covid-lab-leak-origins.html
"Increase in maternal mortality is likely". Glad to see that whole "pro life" thing is going so well. /s
To repeat myself, here’s a law that needs to be passed.
“From the moment of conception, the sperm producer will be responsible for appropriate financial child care related support until the child is 18 years old or 22 years old under special circumstances.”
Beneath the data are hundred of stories of cruelty, confusion and lack of viable treatment. The HCWs are concerned about legality more than healthcare.
This is a well written column with an important and powerful message. When you wrote about covid I could share these columns with my neighbors by sending a link but this no longer seems to be possible. I hope that I am wrong -- your column is too important to be hidden behind a paywall!
Worthwhile reading
https://jamanetwork.com/journals/jama/fullarticle/2806685?guestAccessKey=c532d9c7-f019-4d53-accb-6d3266290534&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=062323
https://www.cbsnews.com/news/ohio-abortion-ectopic-pregnancy-bill-this-ohio-anti-abortion-bill-says-that-ectopic-pregnancies-can-be-moved/
thanks karen! great points! i agree wholeheartedly. it really is a human rights issue when you get right down to it, and that is a great way to frame the issue.