Anti-abortion laws don't only harm women seeking the service

Forty-nine years ago, the Supreme Court gave women the legal right to bodily autonomy. To plan our families so we can welcome children when we are ready. To have control over our economic and career destinies. To have access to safe and optimal health care.

When I started my training as an OB-GYN in 1989, my professors, pointing to the women’s wards, explained that before Roe v. Wade, the beds were full of women injured from illegal abortions. It had been 16 years since the ruling, and my fellow residents and I were grateful to learn how to provide safe, legal abortions — then and now considered essential care for obstetrics and gynecology services. Medical residents with religious or moral objections can opt out of this training.

Having women come in needlessly to access abortion pills drains time and resources.

Fast forward to today. We have the Supreme Court’s decision looming on the Mississippi case that could reverse the rights protected by Roe v. Wade, and states continuing to propose legislation to restrict access to abortion. My state of Georgia passed a six-week abortion ban in 2019 that a federal judge struck down in 2020 because it was unconstitutional, but Republican lawmakers introduced a bill Tuesday to impose new barriers for women seeking medication abortion by banning mail delivery of abortion pills.

The legislation would require a woman to go to an in-person visit to get a physical exam, an ultrasound and sign forms that contain erroneous information. This, when the Food and Drug Administration just did the opposite by removing the in-person requirement to access the pills to be concordant with the science gathered during the Covid-19 pandemic, which has demonstrated safety without an in-person visit.

Besides the direct harm to women and their families, consider the effect of these laws on health care professionals who are already over-stressed and burdened from the pandemic. In Georgia, hospitals and health care workers are stretched so thin from dealing with record high Covid cases that the state’s National Guard was deployed to help. Having women come in needlessly to access abortion pills drains time and resources.

Anti-abortion legislation also forces doctors, nurses and other professionals to violate their ethics of practice.

We can’t expect medical professionals to adhere to ethical principles and risk their lives to serve the public, while also passing legislation forcing them to violate their oaths to ethical practice.

These ethics are symbolized and codified by the oaths we take. A few years ago, I watched my son and the rest of his class of new medical students recite a commitment to the medical profession during a ceremony when they were given white coats. Historically, students recited the Hippocratic Oath written two millennia ago, but now most schools use an updated version or ask each new class of students to create their own pledge. Nursing students have a similar practice and code of ethics.

These oaths represent a promise that we act for the good of the patient, consistent with four ethical principles that guide practice, namely autonomy, justice, nonmaleficence and beneficence.

If I am counseling a woman about her options for any medical treatment or procedure, I must first and foremost respect her autonomy. Her decision must be free of coercion. We help patients make fully informed decisions by explaining the risks, benefits, likelihood of success and alternatives for a chosen treatment or procedure. But when the state bans abortion and denies her options or requires the medical staff to read scripts full of misinformation intended to discourage her from having the procedure, she is stripped of autonomy, and we are forced to breach our principles.

These laws violate the principle of justice, which requires that treatments be available equally to all people in a society. When a state bans abortion, it increases health disparities for people of color and those with lower incomes. Women in these categories already suffer from decreased access to care, higher stress levels, racial discrimination and worse living and working conditions. While people with financial means can travel to other states or countries to obtain abortions, those with low incomes are more likely to have fewer resources to travel or have jobs without paid time off.

Anti-abortion laws violate the principle of nonmaleficence, which is commonly referred to as “do no harm.” Restricting abortion causes harm by leaving women with the options of continuing the pregnancy — including the emotional toll of forced childbirth with or without the option of adoption — or having an illegal abortion. The risk of morbidity and mortality with either of these options is much higher than with a safe, legal procedure.

Carrying a pregnancy to term has a risk of death that is nearly fortyfold greater than the risk associated with legal abortion. The overall maternal mortality rate was 17.4 per 100,000 live births in the United States in 2018, compared with the abortion-related mortality estimate of 0.44 abortion-related deaths per 100,000 legal abortion procedures. Furthermore, pregnancy includes additional risks of morbidities such as diabetes, pre-eclampsia, blood clots, stroke, hypertension, hemorrhage, infection, preterm labor and postpartum depression.

For these reasons, most major medical societies oppose anti-abortion laws. The American College of Obstetricians and Gynecologists states, “Abortion care is essential health care.” Providing essential and optimal care fulfills the fourth principle — that of beneficence. In response to the recent Texas abortion ban, the American Medical Association stated the law “interferes with the patient-physician relationship” and “is a direct attack on the practice of medicine and patient reproductive health outcomes.”

As members of this society, we were grateful for compassionate medical professionals throughout the pandemic, many of whom sacrificed their lives to uphold their commitment to medicine and provide ethical and compassionate care. Neighbors leaned out of their windows to clap, bang on pots and cheer for health care workers. But we can’t have it both ways. We can’t expect medical professionals to adhere to ethical principles and risk their lives to serve the public, while also passing legislation forcing them to violate their oaths to ethical practice. Laws that restrict, or ban, abortions do just that.

Everyone must work to uphold the same ethical principles by acting at this critical juncture. By speaking out, voting and contacting lawmakers, you can join the medical profession to support women’s autonomy, act with compassion, justice, beneficence, and, most importantly, to do no harm.