Access to safe abortions in the post-Roe era

Dr. Monica Saxena JD, MD joins us to discuss the recent overturning of Roe v. Wade. How will this affect access to abortions, particularly for marginalized communities? What relevance does this ruling have to the role of the EM physician in caring for emergencies in pregnancy?  What role with the emergency department play in states that allow and don't allow abortions? What actions may we take for our patients, in the ED and outside the ED?

Objectives

 

1. Explore the changing landscape of safe abortion access in the US

2. Learn how your practice in the emergency department may be affected by the decision to overturn Roe v. Wade, including implications for pregnancy related complaints that include terminataion of pregnancy as treatment (for both states where abortions remain legal and where they do not).

3. Learn what resources exist for you and your patients to navigate safe abortion access in the post-Roe era

4. Learn how you can help restore access to safe abortions 

 

Take Home Points

1. The Supreme Court decision means that regulations or lack of regulation around abortion will be left up to the states. This creates a lot of variation as well as uncertainty.

 

2. Termination of pregnancy is the indicated medical procedure for many complications of pregnancy. In states where termination of pregnancy is banned after a certain amount of weeks or band altogether, the emergency physician may have to wait to intervene until  her patient is unstable or may have to transfer her.

 

3. EMTALA is a federal law which supersedes any state law, however it necessitates the stabilization of patients. In some interpretations, a woman with an emergency related to her pregnancy may have to be unstable prior to the physician intervening.

 

4. The legality around abortion is changing rapidly. The result is that medical decisions are sometimes being legislated in the emergency department. This is dangerous for patients and physicians.

 

5. These laws promote health equity and social injustice as they differentially affect states where there is a larger population of people of color and indigenous peoples.

 

6. Physicians interested in helping can do so in the following three ways:

a) Advocate for a change with your national college. For us that is the American College of Emergency Physicians and the Society of Academic Emergency Medicine

 

b) familiarize yourself with what options your patients have and where they can turn to for resources. It may be possible to get training in medical abortion depending on where you live

 

c) states where abortion remains legal will see an Increasing volume of patients seeking termination of pregnancy. There may be scope to to set up innovative programs for medical termination in the emergency department

 

Resources

Abortion providers near you: https://abortionfinder.org/ 

Teleabortions: https://mychoix.co/

Emergency Medicine and Reproductive Health in a Post-Row Landscape  Kelli L. Jarrell et al

Monica Saxena: [email protected]

 

Guest

Monica Saxena is an assistant professor of Emergency Medicine at Stanford School of Medicine. She is also a JD who has been involved in reproductive rights and women's health for more than a decade. Dr. Saxena initiated an ED protocol for elective termination of first trimester pregnancy in the ED.

 

Contributors:

Payal Modi