The recent Dobbs v. Jackson Women’s Health Organization The Supreme Court’s decision has had a lasting impact on the socio-political fabric of the nation and on the practice of emergency medicine, the emergency physicians and the communities we serve.
All emergency physicians have taken the Hippocratic oath and declared that they will do no harm or injustice to patients. We must consider the consequences of laws that affect emergency medical care and the health of our patients despite our individual political views. The nation’s success and livelihood depend on the health and well-being of all its people, and it is imperative that Americans recognize the value of women in this society.
The health and well-being of society is at risk when the health and well-being of women is at risk. A study examining health, economic and social rights in 162 countries found that countries with strong economic and social rights for women were more likely to have better overall population health outcomes and faster growth with sustainable development. (BMJ open. 2019;9:e021350; https://bit.ly/3JA4qsN.)
The maternal mortality crisis in the United States is well documented: American women have the highest rate of maternal deaths among high-income countries, while black women are nearly three times more likely to die from complications related to to pregnancy than white women. (The Commonwealth Fund. 5 April 2022; https://bit.ly/3d58DIS.)
Death rates from preventable causes, including pregnancy-related complications, among women of childbearing age in high-income countries are highest in the United States, according to this Commonwealth Fund report. And non-Hispanic black women represent the highest abortion rates in the United States, while non-Hispanic white women represent the racial and ethnic group with the lowest abortion rate, according to the report, so Dobbs vs. Jackson will affect black women more than any other racial group in the country.
At a time when the country has begun to re-examine the impact of systemic anti-Black racism, there is a need to understand the extent to which current laws directly contribute to systems of oppression that cause substantial health inequities that put endanger the lives of black people. .
Costs of refused abortions
Society is still discovering the full impact of Dobbs vs. Jackson decision. Basic knowledge described the direct effects of stricter abortion laws and abortion bans on the morbidity and mortality of patients seeking abortion care.
States with stricter abortion laws, such as Alabama, Arkansas, Kentucky, Louisiana, Mississippi and Tennessee, recorded more than 30 maternal deaths per 100,000 births between 2018 and 2020. States with more permissive abortion laws, such as Illinois and California, had 12 and 10 maternal deaths per 100,000 births, respectively. (Guttmacher Institute. Aug. 2, 2022; https://bit.ly/3PYX2cS.)
A University of Colorado study estimated that a total ban on abortion in the United States could increase the total number of pregnancy-related deaths by up to 21%, with up to 33% increase pregnancy-related deaths among blacks. (Demography. 2021;58:2019.)
The Turnaway study, conducted at the University of California, San Francisco, selected 1,000 patients who were turned away from 30 abortion centers across the country because of their gestational age limit. (Women’s health issues. 2014;24:e115.) The study highlighted how denial of abortion care affected physical and mental health as well as patients’ employment, education, and relationship status. Women who gave birth after being denied an abortion reported more life-threatening complications, such as eclampsia and postpartum hemorrhage, than those who had voluntary abortions.
According to the study, patients who were denied an abortion were also nearly four times more likely to live in a household below the federal poverty level and three times more likely to be unemployed, and they were more likely to stay with abusive partners. And existing children of women refused abortions were less likely to reach developmental milestones than existing children of women who had abortions. The results of this study amplify the significant societal impact of abortion refusal by highlighting the degree of lasting economic hardship and the negative impact on child development.
EMTALA is clear
The Dobbs This decision highlighted a divide in our country, but the Emergency Medical Treatment and Labor Act unites emergency physicians across the country. EMTALA requires that all patients receive appropriate medical screening, stabilization treatment, and referral, if necessary, regardless of any law or state mandate that applies to specific procedures.
The Centers for Medicare and Medicaid Services recently released a memorandum to remind and guide emergency physicians in managing pregnancy-related complications after the Supreme Court ruling, noting that EMTALA should be followed when a direct conflict occurs between it and any state law. “Strengthening EMTALA Obligations Specific to Pregnant and Losing Patients.” Centers for Medicare and Medicaid Services. July 11, 2022; https://go.cms.gov/3d9zEe2.)
EMTALA is clear: an emergency physician who considers that a pregnant patient suffers from an emergency medical condition, for which abortion is the stabilizing and necessary treatment, must provide this treatment, according to the CMS. It’s a reminder that abortion care doesn’t just happen in abortion clinics. Many patients initiate this treatment in the emergency room for pregnancy-related complications. Abortions, like pericardiocenteses and thoracotomies, are life-saving procedures in more ways than one considering the lasting socio-economic impact seen in people deprived of this medical treatment.
Emergency physicians across the country will undoubtedly see an increase in the number of patients with pregnancy-related complications. Some will see an influx of patients seeking abortion services not provided in their home country. Others may see more patients with complications from attempted self-administered abortions.
ED is a microcosm of our society. The EP’s duty has never seemed greater during a rapidly evolving pandemic in an ever-changing geopolitical landscape. We must remember our oath to do no harm and to prevent injustice to those we serve.
Dr. Knightis the Director of Faculty Experience at Zuckerberg San Francisco General Hospital and Trauma Center, the Associate Chair of Diversity and Inclusion in the Department of Emergency Medicine, and an Endowed Professor of Diversity, equity and inclusion in emergency medicine at the University of California, San Francisco. Follow her on Twitter@StarrKnightMD. Read his past articles onhttps://bit.ly/DiversityMatters-EMN.