Since Politico obtained a draft majority opinion from the Supreme Court striking down Roe v. Wade, patient and provider advocates as well as Democratic lawmakers have harshly critiqued the potentially historic decision.
They say drafts like this sow fear and confusion and could lead to a spike in unsafe abortions, particularly among people of color, despite the right to abortion still being protected. In a Senate hearing on the upcoming budget for his department, Department of Health and Human Services (HHS) Secretary Xavier Becerra called the news "chilling," saying HHS is "not in the business of stripping Americans of access and protections to care" and will "double down" on its authorities to protect the right to reproductive health care. In the past, the agency has provided grants to clinics and outlined protections for healthcare workers and pregnant people.
National Nurses United went a step further, calling the decision an escalation of "domestic terrorism."
The Biden administration, meanwhile, has said it would look to past initiatives like funds to expand access to emergency contraception as a road map if Roe v. Wade is overturned. However, experts worry that the government's options for aid are limited, and President Joe Biden has been criticized for a weak response to the draft opinion.
At a Milken Institute event streamed online Wednesday, Centers for Disease Control and Prevention Director Rochelle Walensky emphasized that without Roe v. Wade protections, access to abortion care will be unequal depending on a person's ethnicity, where they live and the resources they have. For those who cannot cross state lines for a safe, legal abortion, "I do think that lives could be at stake," she said.
More than a dozen states have trigger laws banning abortion that would be activated if Roe v. Wade is overturned. Many others are swing states but are seen as likely to also enact bans. In D.C. and 15 states, the right to abortion is seen as protected long-term.
“Abortion bans absolutely create barriers for people in need of abortion care, and they perpetuate fear and confusion that stymie access to other essential facets of pregnancy care,” Jen Villavicencio, M.D., lead for equity transformation at the American College of Obstetricians and Gynecologists (ACOG), told Fierce Healthcare.
If final, the decision “will have a horrific impact on people’s lives, autonomy and health” and will be “acutely felt by people with low incomes,” the National Family Planning & Reproductive Health Association said in a statement.
“Abortion is still legal; this draft does not change that,” Stephanie Mischell, M.D., an abortion provider in Texas and a fellow with Physicians for Reproductive Health, told Fierce Healthcare.
Part of her role as a physician is communicating the latest accurate information to patients, she added.
“As politicians do their debating, my co-workers and I continue to show up to our clinics to provide care for the pregnant people of our communities,” she said. “We are committed to providing this care for as long as we possibly can.”
Experts also emphasized that these sorts of decisions are not grounded in science or concerns for safety. “Allowing the government to control the choices people with ovaries make regarding their reproductive care will put their health and lives at risk,” Carrie SiuButt, CEO of birth control provider SimpleHealth, said in a statement.
“I think there are a lot of unanswered questions about what the fallout will be,” Georges C. Benjamin, M.D., executive director of the American Public Health Association, told Fierce Healthcare. “How do we provide for women in one state who go to another sate to get that abortion? How do they get effective follow-up care?” These and many other legal and logistical questions are the reason a national framework for how to proceed is needed, Benjamin stressed.
To prepare for the possibility of the decision being formalized, ACOG is looking to advance medical education and training on providing abortion care and to refer patients to available care, including in other states. “An expanded network of clinicians across medical specialties will be essential to help patients access needed abortion care regardless of where they live,” Villavicencio said. The organization is also looking to provide training access globally and continuing education for those interested in adding abortion care to their practices.
The benefit of the leak is it allows for the possibility of a post-Roe reality to sink in among those who had doubts the court would go this far, Benjamin said. And “it gives time for contingencies, but in the meantime, there will be women who will need an abortion but will not seek it.”