1. Zolot, Joan PA


Limits on abortion may further increase U.S. maternal morbidity and mortality.


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Legislation passed this year in several states would significantly curtail a woman's ability to obtain an abortion. Six states this year-Georgia, Kentucky, Louisiana, Mississippi, Missouri, and Ohio-ban abortion after detection of a fetal heartbeat, effectively at six to eight weeks of pregnancy. A seventh state, Alabama, permits abortion only to save a woman's life; abortions for any other reason are crimes punishable by imprisonment for those who provide them. And Georgia grants legal "personhood" status to fertilized embryos.

Figure. Georgia gove... - Click to enlarge in new window Georgia governor Brian Kemp signs HB 481, the "heartbeat bill," on May 7 in Atlanta, setting the stage for a legal battle as the state attempts to outlaw most abortions after about six weeks of pregnancy. Photo by Bob Andres / Atlanta Journal-Constitution via Associated Press.

None of these laws have taken effect and all are being challenged in court. Should these lawsuits reach the Supreme Court and result in overturning Roe v. Wade, the federal law that currently grants women the right to terminate pregnancies, the consequences could have an effect on all U.S. women and their families. Advocates for maintaining the law contend that health risks from unwanted pregnancies would likely fall disproportionately on poor and marginalized women, including women of color, immigrants, minors, and women living in rural areas.


In regions where abortion is illegal or unavailable, studies show that women tend to seek unsafe or illegal abortions or try to induce abortion by ingesting herbs or inflicting trauma to the abdomen. Up to 13% of maternal deaths worldwide are attributable to clandestine or unsafe abortions, which carry the risk of complications, including hemorrhage, infection, sepsis, trauma, and death.


In the United States, oral misoprostol and mifepristone are Food and Drug Administration-approved medications to safely induce abortion in the first 12 weeks of pregnancy. Self-managed abortion at home, when using approved abortion-inducing pills without clinical supervision, has been deemed safe and effective by the World Health Organization. Advice is available from telemedicine programs and websites that offer online protocols for use of abortion medications.


Many questions remain about the broader impact of each of the recently passed state abortion bans, should they take effect. For example, the contraceptive intra-uterine device (IUD) acts by preventing implantation of a fertilized egg, which the Georgia statute deems a person. Might this, therefore, make IUDs unavailable to women residing in Georgia? When pregnant patients present with vaginal bleeding, might clinicians decline to help for fear of prosecution? And might women with vaginal bleeding-which can indicate fibroid tumors or cancer in addition to pregnancy problems such as miscarriage-delay seeking medical help?-Joan Zolot, PA