Special Section - Reproductive Health and Rights
Why Continue to Speak Out and Advocate to End the Criminalization and Banning of Reproductive Health Care Services for Women?
IT IS THE BEST AVENUE FOR CHANGE Laura Esserman, MD, MBA Restrictions on reproductive health services are threatening the lives and well-being of women of reproductive age, including those with planned as well as unplanned pregnancies. These laws particularly punish women of lower socioeconomic status. As healthcare providers, we must continue to work to reverse these laws. As medical professionals across specialties, one concrete action we can take is to urge that all medical conferences move to states that fully recognize the rights of all women and support full access to health care services across the continuum, including reproductive care. This is an issue equality, dignity, respect, and equity. It is important to reflect on a fifty year social movement that eventually led to overturning Argentina’s ban on abortion that included criminalization of the women (up to 14 years in jail) as well as those who aided them (up to 4 years in jail). Hundreds of thousands of women came together as the “Green Wave” and finally succeeded in convincing Argentina’s lawmakers to decriminalize and ensure safe access to abortion. A critical reason for their success was advocacy, the size of the campaign, the persistence of those in the movement, the recognition that thousands of women had been hospitalized or died because of the restrictive laws. And the brunt of those who suffered fell on the poorest women with the least access to resources. In Ireland, another predominantly Catholic country where abortion had been illegal even in cases of rape, there was a high-profile case of a 31 year old woman who was a dentist and 17 weeks pregnant. She was denied care during her miscarriage because of the presence of a heartbeat. By the time the heartbeat ceased, the young woman developed sepsis and died. The publicity surrounding this case galvanized a new wave of activism leading to a law that allowed abortion to protect a woman’s life. In 2018, a referendum repealing the Eighth Amendment eventually passed 66% to 34%, with abortions in the first trimester covered by the public health service. Activism is the key to changing laws. We are just starting to hear about the many lives that are being lost in the United States in states where abortion is banned or effectively banned. We cannot sit back and see history repeat itself here in the United States of America. The United States is a pluralistic society and embraces people of all cultures and religions, who hold different views about fetal viability. Each person should be free to follow the dictates of their own beliefs but should not impose their beliefs on others. We as physicians should recognize the inherent dangers being imposed on women and be part of the social movement that demands change. The Supreme Court, with the Dobbs v. Jacksons Womens 24
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Health decision in 2022, overturned the Roe v. Wade precedent that allowed women to make their own decisions about reproductive health. The Dobb’s ruling allowed states to pass their own laws to legalize, ban, or criminalize abortion. This ruling has led to an outright ban in 13 states, and significant restrictions in others, though in a number of these states, citizens are approving constitutional bans to legalize abortion. In many states, physicians who provide pregnancy termination services face criminal prosecution, jail time, and fines. States like Texas have gone further, turning citizens into bounty hunters to sue neighbors and anyone helping persons for providing medical advice and services. The vigilante provision is meant to harass and frighten medical providers to stop doing their jobs. Justice Sonia Sotomayor has called this measure “a flagrantly unconstitutional law engineered to prohibit women from exercising their constitutional rights and evade judicial scrutiny.” Fortunately, many states have voted to enshrine access to abortion in their constitution (California, Maryland, New York, Nevada, Arizona, Montana). A number of states have also passed shield laws. Shield laws allow providers in one state to prescribe and send medication abortion to individuals who live in a state where access to abortion is banned.1 The following states have shield laws: California, Colorado, Maine, Massachusetts, New York, Vermont, Rhode Island, and Washington.2, 3 On November 6, seven of 10 ballot measures protecting abortion passed. In Missouri, the first state to ban abortion after the Dobbs decision, even in the case of rape, voters approved an amendment guarantees abortion access up to the point of fetal viability, generally the 24th week of pregnancy. There are still 17 states that have near total ban on abortions. Unfortunately, the majority of those state are in the South and form a huge geographic block which compounds the difficulty of leaving to go to a state that where abortion is legal. I am lucky. I live in a state that was one of the first to pass a constitutional right to access abortion up until the point of fetal viability, and to protect women who travelled to California to access abortion services from being prosecuted by their home states that ban abortion. But because women in my state are safe, that is not sufficient reason for me to turn a blind eye to what is happening in other states in this country. States that discriminate against women by banning reproductive freedom directly harm the physical and mental health of women and those that care for them. It also violates the right to privacy between physician and patient.4 We have all read about several high profile cases of young women losing their ability to have children because of sepsis and the need for a
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