Trauma of abortion restrictions and forced pregnancy: urgent implications for acute care surgeons

Abstract

In the aftermath of the Supreme Court's Dobbs vs. Jackson Women's Health decision, acute care surgeons face an increased likelihood of seeing patients with complications from both self-managed abortions and forced pregnancy in underserved areas of reproductive and maternity care throughout the USA. Acute care surgeons have an ethical and legal duty to provide care to these patients, especially in obstetrics and gynecology deserts, which already exist in much of the country and are likely to be exacerbated by legislation banning abortion. Structural inequities lead to an over-representation of poor individuals and people of color among patients seeking abortion care, and it is imperative to make central the fact that people of color who can become pregnant will be disproportionately affected by this legislation in every respect. Acute care surgeons must take action to become aware of and trained to treat both the direct clinical complications and the extragestational consequences of reproductive injustice, while also using their collective voices to reaffirm the right to abortion as essential healthcare in the USA.

Keywords: Health Care Quality, Access, And Evaluation; Healthcare disparities; health policy; pregnancy.

Figure 1

States were determined to be restrictive or protective of abortion based on the Alan Guttmacher Institute criteria as previously described. The CDC Wide-ranging ONline Data for Epidemiologic Research (WONDER) was queried for the years 1999–2019 for multiple causes of death with assault (X85–Y09) and/or intentional self-harm (X60–X84) as the underlying cause of death in women ages 10–54 and obstetric codes (O00–O99) as contributing for each subset of states. For the years when the CDC suppressed the value due to low numbers (< 10 /year), the highest possible suppressed value of “9” was entered as the high end of possible deaths. The rate was calculated against the listed population in that age group at that time and then also normalized against the number of live births in the included states (CDC) for that year. The pregnancy “check box” was notably added to all state death certificates during the years 2003–2017 (most states completed addition by 2010) allowing for greater sensitivity for detection of maternal death since ~2003; however, in previous reverse binomial regression analyses, state addition of the check box did not significantly correlate in time with increases seen in maternal mortality between the states. CDC, Centers for Disease Control and Prevention.