Reproductive Health in the Face of Changing Legislation

Reproductive health in the face of changing legislation

The 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health overturned the landmark 1973 case Roe v. Wade. As a result, access to reproductive health care has been significantly, if not uniformly, impacted across the United States.  

Some states’ laws regulating abortion access remain unaffected. However, it remains important for nurses, physicians, and other healthcare professionals who care for pregnant patients to understand the history, context, and scope of the Dobbs decision. 

Related podcast: Women’s Reproductive Health Issues in the Face of Changing Legislation 

Roe v. Wade 

The case that decided abortion rights in the US for over 50 years began in 1970. Texas law forbade all abortions unless it would save the life of the mother. Norma McCorvey, known in the lawsuit as Jane Roe, sought an abortion for her third pregnancy but was unable to access a clinic in Texas.  

Texas legislators looking to challenge the law brought the case under the argument that abortion bans were unconstitutional, as it infringed on the right to personal privacy. Decided by the US Supreme Court (SCOTUS) in 1973, Roe prevented states from legislating against abortion prior to fetal viability. 

Roe served as a precedent for SCOTUS cases regarding other questions of personal privacy, including marriage equality and contraception access. 

In a 1992 case, Casey v. Planned Parenthood of Southeastern Pennsylvania, SCOTUS upheld Roe on the grounds that the 14th Amendment protected a citizen’s right to privacy, which covered reproductive issues.  

Dobbs v. Jackson Women’s Health Organization 

A 2014 state law in Mississippi prohibited pregnancy termination beyond 20 weeks. Even though that limit conflicted with the accepted viability threshold of 24 weeks, until Dobbs, no one had legally contested it. The Dobbs case followed a 2018 Mississippi law that banned most abortions after the 15th week of pregnancy. 

In the SCOTUS decision, the court ruled that abortion is not specifically protected by the 14th Amendment, or anywhere else in the Constitution, as it is not a practice “deeply rooted in the Nation’s history and tradition” nor necessary for “ordered liberty.” Thus, SCOTUS determined, the federal government could not provide blanket protections for abortion rights.  

State-level legislation 

The ruling did not make all abortions illegal. Rather, the Dobbs decision shifted the onus for regulation back to the state governments. In states with stricter laws, this has significantly restricted access to abortion services.  

Most states have legislation that either supports access to abortion or limits abortions access based on gestational age or fetal cardiac activity. If the proper reports have been filed, some states allow for abortion when pregnancy is the result of rape or incest. Some states also have exceptions for medical emergencies where pregnancy would put the mother at risk of harm or death.  

Enforcement of these laws varies. In Texas, for example, a citizen can file charges against an abortion provider. In other states where abortion is illegal, only law enforcement can prosecute abortion providers or patients seeking an abortion. 

Insurance considerations 

Even before Dobbs, most insurance plans did not provide adequate coverage for elective abortions, despite the identical procedures being used—and likely covered—in cases necessary for the life and safety of the mother.  

The Hyde Amendment, which took effect in 1980, prohibits use of federal funds for abortion services except in cases of rape, incest, and severe maternal risk. However, states can continue to use their own funds to support abortion services within their Medicaid programs, which provide healthcare to low income and special needs populations.  

The impact on patients and clinicians 

The impact of the Dobbs ruling extends beyond abortions. Many clinics that offer abortions also provide women’s reproductive health care, including contraception and screenings for breast and gynecologic cancers. In places where these clinics have been closed, patients have lost access to valuable wellness and preventative services.  

In addition to fewer facilities, the ruling may contribute to staffing shortages in areas of greatest need. Healthcare professionals may choose to practice in states with a lower risk for litigation. In states where abortion is legal, a professional caring for a patient with a desired, but sadly non-viable, pregnancy can offer options, from medication to a dilation and evacuation, or D&E, procedure.  

In states where abortion is illegal, the healthcare professional must balance the best options for patient care with existing restrictions. Since D&E procedures for missed abortions or nonviable pregnancies are identical to an elective termination, they must consider the regulations around the procedure itself, regardless of reason.  

Eliminating barriers to care 

Given changing legislation and inconsistencies across state lines, it is critical for healthcare professionals to stay on top of the laws in their area of practice. Healthcare professionals should also strive to educate their patients about prevention and contraception methods.  

In a rapidly changing legislative environment, it falls to clinicians to continue working to identify and eliminate barriers to care for their patients.