Abortion policy in the United States has been transformed by the Supreme Court decision to overturn Roe v. Wade (1973). Women's health care providers across the country are facing a dichotomy of practice implications in response to what is now a national redistribution of reproductive health care services, whereby access became severely restricted in some states, and consequentially expanded in others. Although the impact of this Supreme Court action on women and children's health outcomes is not yet fully realized, there is need to contemporize nursing care to address intensified regional disparities in reproductive health options.
What does it mean to "overturn" Roe v. Wade? A person's constitutional right to have an abortion or continue a pregnancy no longer not exists. Overturning Roe v. Wade does not define whether one can or cannot have an abortion. Rather, one's right to choose to have an abortion or continue a pregnancy is no longer protected by the constitution of the United States.
What laws changed? There were approximately two dozen states with "trigger laws" or pre-Roe bans that immediately limited or banned procedural and medication abortion access when Roe v. Wade was overturned. New legislation is underway in some of these states to limit postcoital contraception (e.g., intrauterine device), regulate cryopreserved embryos, and prosecute those who attempt to bring or send reproductive health care services across state lines (e.g., mail order mifepristone; Guttmacher Institute, 2022).
What patient care changes can we anticipate? Imposing restriction on reproductive health care increases health risks for women and results in economic insecurity, especially in lower-income families and for women of color. There is an almost four-fold increase in odds that household income will fall below the federal poverty level after being denied a desired abortion (Miller et al., 2022). In regions with restricted access to abortion, perinatal health care providers are seeing an overall increase in parity, including grand multiparity, as well as more births associated with sexual violence and rape. Nurses should plan to advocate for expanded access to mental health care and social services for women facing these challenges.
Nurses should be prepared to care for an increased number of women with delays in seeking prenatal care, as well as with pregnancies complicated by unsafe abortion attempts. Methods of unsafe abortion include drinking toxic fluids; ingesting teratogenic or labor-inducing herbs, inflicting direct injury to the vagina, cervix, or rectum; or repeatedly striking the abdomen. Unsafe abortion is a major global health challenge, with complications that include sepsis, peritonitis, hemorrhage, poisoning, and organ necrosis. According to the World Health Organization, over 25 million unsafe abortions occur each year and are responsible for pregnancy complications and for nearly 8% of maternal deaths (Say et al., 2014). There are many online sites promoting use of black cohosh, parsley, and even mercury for birth control or to induce abortion. In preparing for diminished access to safe abortion, and an expected turn to alternatives, nurses should be cognizant of social media trends and predatory publications advertising "abortifacient properties" of mail-order products, herbs, and other ingestibles.
Maternal-child nurses have long supported policies to reduce maternal mortality, promote health equity, eradicate structural racism, protect the patient-provider relationship, eliminate food insecurity, and improve health care delivery for all. In considering the predictable way overturning Roe v. Wade undermines these priorities, the editors of MCN. The American Journal of Maternal-Child Nursing strongly denounce the U.S. Supreme Court's decision.
References