Medical Groups, NEJM Editors Urge Abortion Rights Protection

Troy Brown, RN

September 04, 2019

Five medical associations and the editors of the New England Journal of Medicine (NEJM) published a joint editorial today emphatically supporting the protection of abortion rights afforded by the US Supreme Court in Roe v Wade.

The editorial by the NEJM editors, American Board of Obstetrics and Gynecology, American Gynecological & Obstetrical Society, Council of University Chairs of Obstetrics and Gynecology, Society for Academic Specialists in General Obstetrics and Gynecology, and Society for Maternal–Fetal Medicine (SMFM) was published online September 4 in NEJM.

"We are publishing this content now because of deep concern over measures that have negatively impacted women's health in specific states," NEJM spokesperson Jennifer Zeis told Medscape Medical News.

"Access to legal and safe pregnancy termination, a legal right in the United States for the past 46 years, is essential to the public health of women everywhere. None of us want to return to a time when desperate women, often of limited means, sought unsafe pregnancy terminations and suffered irreversible harm and sometimes death," the editorial states.

The authors say that the number of abortions per 1000 reproductive-age women each year is lower now than it was right after the Supreme Court legalized a woman's right to an abortion in the United States in January 1973. In addition, deaths from unsafe abortions have been all but eliminated here. The authors note that the majority (90%) of abortion procedures now are performed during the first trimester, "when the risk of maternal mortality is less than one tenth of that associated with carrying a pregnancy to term."

When asked about the editorial, Brian Iriye, MD, SMFM president, said in a statement, "The SMFM supports a woman's right to access the full spectrum of reproductive health services, including abortion. Current abortion services are safe and decisions about reproductive health are best made by an informed woman in consultation with her healthcare provider.

"Because maternal–fetal medicine (MFM) physicians primarily provide care to women experiencing high-risk pregnancies, the SMFM is particularly concerned with access to reproductive health services for this population. MFM patients are at higher risk for maternal mortality and morbidity and in certain cases, access to contraception and abortion can be lifesaving," Iriye explained.

The Centers for Disease Control and Prevention has records of the reduced deaths; however, there is no official national record of how many women suffered from critical illness or lost their ability to have children in the future as a result of injuries and infections from unsafe abortions, according to the editorial.

The World Health Organization (WHO) estimates 22 million unsafe abortions are performed each year in countries that have limited or no availability of safe, legal abortions, according to the editorial. Tens of thousands of deaths and millions of permanent disabilities occur as a result of these unsafe abortions, and the WHO reports "nearly every one of these deaths and disabilities could have been prevented through adequate provision of public health services, including sexuality education, family planning, and legal induced abortion," the authors write.

The editorial authors remind readers that although many can remember seeing for themselves what happens when women undergo illegal, unsterile abortions at the hands of unskilled providers, others have learned these things from history. "Sadly, however, we will not need history as our teacher if Roe is overturned by the Supreme Court, because we will again witness deaths and permanent injuries of women desperate to terminate pregnancies," they write.

"Moreover, inequality will become more marked as our country becomes further divided by a mosaic of state laws," the editorialists continue. "The inevitable result is that while affluent women will continue to have access to safe and affordable contraception and, when that fails, abortions, across state lines if necessary, marginalized and less affluent women will not have access to needed preventive services, and they will again resort to unsafe abortions and suffer the consequences."

Safe, legal abortions are already so heavily restricted that they are "virtually unavailable" to tens of millions of US women, the authors write.

They add that deciding to end a pregnancy is "deeply personal and difficult" and should be "the prerogative of each woman and her care provider and not be usurped by the government."

The medical associations and NEJM editors together write that it would be a "grave mistake" to reverse Roe, that doing so would endanger the health of women in the United States, and they "strongly advise" keeping it as the law in each state.  

"It is impossible to know what the future will bring," Zeis said. "This editorial is meant to address events that have already occurred and do not show signs of abating."

SMFM has previously published recommendations in the American Journal of Obstetrics & Gynecology on reproductive services for women at high risk for maternal mortality, which emphasizes the society's "opposition to legislation and policies that limit a woman's ability to access abortion," Iriye said in the statement.

"Once a woman makes the private decision to follow this path, she should be able to do so in a manner that does not put her or her loved ones at risk. We have lived within the guidance of Roe v Wade for nearly half a century; it has protected women from injury and death," the editorial concludes.

N Engl J Med. Published online September 4, 2019. Full text

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