Overturning Roe v. Wade will affect the quality and availability of maternal medical care across the U.S., exacerbating a problem that has been building for years as abortion restrictions have already tightened in parts of the country.
Doctors say stricter laws make it more difficult for women to get the most medically appropriate treatments for miscarriage because the medical and surgical procedures to remove a failed pregnancy are the same as those used for an abortion. The consequences may affect future fertility or, in severe cases, increase the risk of maternal death.
“Abortion laws already have an out-sized impact on folks who are experiencing early pregnancy loss, early pregnancy complications, and later complications,” said Jen Moore Conrow, a board member of Abortion Care Network who consults with abortion clinics and health care systems. “I expect that will only get worse in a post-Roe environment.”
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Physicians in several states said they’ve already seen patients who failed to get proper care because of state laws, Catholic hospital policies, or a lack of proper clinician training, all of which are likely to increase if the landmark 1973 decision protecting abortion rights is overthrown.
No Access
Jessika Ralph, an OB-GYN and assistant professor at the University of Minnesota’s medical school, has cared for several patients who live in neighboring states with more restrictive abortion laws — including one who was carrying a fetus without a heartbeat but couldn’t find an in-state doctor willing to perform the surgical procedure to remove it. That procedure, a dilation and evacuation, is used in both miscarriages and abortions.
Anuj Khattar, a family medicine doctor with the Cedar River Clinics in Washington, which operate in the Seattle area, has been traveling across the country to treat patients for years, as abortion laws have gradually become more restrictive. Four or five years ago, he said, he was working in Oklahoma when a hospitalized patient needed a dilation and evacuation — and the hospital couldn’t find a single local doctor to do it.
“I did the procedure in 15 minutes,” Khattar said. “I remember asking the provider, ‘What would you have done if I hadn’t been in the state?’ They would have probably removed her uterus.”
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Miscarriages before 20 weeks are common, occurring in about 10% to 20% of all known pregnancies, according to the Mayo Clinic. Sometimes, all of the pregnancy tissue leaves the body without medical assistance. Other times, medications or surgical procedures may be necessary.
Women may be offered mifepristone and misoprostol, which are the same drugs used to terminate a pregnancy. Or they might be given the option to undergo a procedure to physically remove the fetus, a treatment that is also used in abortion.
“There is very little distinction between miscarriage treatment and induced abortion at really any time during gestation,” said
Maternal Risk
Without federal abortion protection, doctors may not be able to offer such treatments. While some state laws provide exceptions if the life of the mother is in danger, assessing that risk is not always clear-cut. So, doctors are concerned about what will happen in cases when terminating a pregnancy is necessary to protect a woman's health, even if her life is not immediately at risk."
“We would never say to other patients of other medical problems of any kind, ‘Oh, we won’t treat you until the last minute," Westhoff said. “What you’re asking is for the woman and the clinicians taking care of her to just tolerate a gradually worsening situation at greater and greater risk to her health until some unknown moment when the scales tip and now it’s an immediate risk to her life."
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Cassing Hammond, an OB-GYN and associate professor at Northwestern University’s medical school, often sees women who have premature rupture of membranes in the second trimester; the sac containing the fetus starts to break and amniotic fluid leaks into the uterus. Sometimes, the membranes can reseal but often that doesn’t happen, putting the woman at risk for infection. Currently, Hammond’s patients can choose whether to evacuate the uterus – which is the same procedure as an abortion – or wait to see what happens.
Infections are more dangerous for some women, such as those who have diabetes or are immunocompromised. “We need the kind of latitude in medicine to work with our patients and help them make the decision that’s right for them,” Hammond said.
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The vulnerability of Roe V. Wade comes as pregnancy-related deaths are rising in the U.S. According to the U.S. Centers for Disease Control and Prevention, the maternal mortality rate increased 37% between 2018 and 2020, to 23.8 deaths per 100,000 live births. It was more than twice that among Black people while Hispanic people had the lowest rate.
Meanwhile, eliminating federal abortion rights may also make it more difficult for doctors-in-training to learn how to provide the full spectrum of care for miscarriage. Papers published in 2018 and 2022 showed that medical residents in programs with routine abortion training were more likely to know how to do more types of miscarriage treatments.
“This is actually obstetrics,” said Courtney A. Schreiber, an OB-GYN and chief of family planning at the University of Pennsylvania’s medical school. “There are a lot of outcomes to a pregnancy, and we as a society need to be prepared to take care of all of those.”
