Doctors on an Abortion Ban: Unnecessary Health Risks, Stress on Safety Nets
DURHAM, N.C. -- An abortion ban would create a broad swath of unnecessary health risks for women while also creating risk and reluctance for doctors who care for them, three Duke doctors said Tuesday.
In overturning Roe vs. Wade, the U.S. Supreme Court would put myriad new obstacles in the path of pregnant women while adding significant stress to the nation’s already-burdened social safety net, experts said during a virtual media briefing for journalists. (Watch the briefing on YouTube.)
Here are excerpts:
ON ABORTION AND INDIVIDUAL FREEDOM
Dr. Jonas Swartz, assistant professor, Obstetrics and Gynecology
“Abortion is an incredibly safe and effective procedure as it’s practiced across the United States today. It’s essential health care and gives people the right to autonomy over their own bodies. When I think about the loss of that right, the loss of access to that safe and effective care, it worries me for my patients, and it worries me for my kids.”
“Pregnancy is a wonderful thing. It is also a time in a person’s life when they can face significant health risks. For people who have an unwanted pregnancy, often abortion can be a much safer option.”
“People should have the freedom to make decisions about their own health risks and not to have to face those risks because they’re carrying an unwanted pregnancy.”
“When we take away the right to safe and legal abortion, that doesn’t take away abortion overall. It just means people try to access through means that are less safe.”
ON THE REAL IMPACT OF AN ABORTION BAN
Dr. Beverly Gray, founder, Duke Reproductive Health Equity and Advocacy Mobilization team
“For a lot of folks in our country, they’re already living in a post-Roe existence. We’ve already seen many patients who have limitations on their access to care based on where they’re born, where they live, what type of insurance coverage they have, how much money they have saved in the bank.”
“These are real-life impacts on ordinary people seeking abortion care. We care for many patients who have life-threatening medical conditions in which abortion saves their lives.”
“There’s a lot of stigma around abortion in our country, so people don’t talk about their abortion. But we know that by the time women reach menopause, around 1 in 4 of those women will have had an abortion.”
ON IMPLICATIONS OF AN ABORTION BAN
Dr. Richard Shannon, chief quality officer, Duke Health
“There could be a whole host of implications, most of which have not been carefully thought out. What does this mean for the concept of individual rights? What does this mean for the growing public health crisis of maternal morbidity and mortality? What does it mean to the child welfare state? What does it mean to foster care? There are broad implications.”
“If the federal statute is overturned and states are given the opportunity to choose on behalf of individual women, I think we have to recall (how) this nation was founded; this nation engaged in a revolution, fighting against such tortious government interference. The idea that a monarchy could reach across and interfere in individual rights was the founding principle of the nation. How does this differ?”
ON AN ABORTION BAN AND ALREADY HIGH U.S. MATERNAL MORTALITY
Dr. Jonas Swartz
“The maternal mortality crisis in the United States is a real challenge. It’s not just that we have the highest rates of maternal mortality among industrialized countries, it’s also that we have significant health disparities in terms of who suffers.”
“We know low-income people, people of color are more likely to die during pregnancy and have major morbidity during pregnancy.”
“I regularly see patients who make the very rational choice for them and for their families about what the best time is for them is to have a pregnancy, or to carry a pregnancy, or not have a pregnancy. Often times that is made because of the health of the mothers. We regularly care for patients who need to focus on their own health, and the pregnancy significantly puts that health at risk. They need to be free to make the choice to end the pregnancy in that situation.”
ON A SPILLOVER EFFECT FROM STATE TO STATE
Dr. Beverly Gray
“This will impact care for North Carolinians, for people in Durham, if other states have bans. We’re already seeing an increase in cases from the spillover effect. Bans in Texas and Oklahoma influence where those patients can get care, so they’re going to surrounding states. Those folks in surrounding states are getting delays in care ... and they come to other states. We’re seeing this tidal wave effect of folks seeking care. The vast majority of abortions happen in the first trimester; if you have delays in care due to access, that is going to shift.”
“States are already thinking about how they’re going to care for patients who have severe medical illnesses and other complications to their health. I think people are really, really worried about the impacts this is going to have immediately and then down the road.”
ON PRENATAL CARE AVAILABILITY
Dr. Richard Shannon
“You could be looking at 600,000 to 800,000 more births a year. We don’t have enough obstetricians and medical care in general to attend to the women who come to us today. There are about 4 million live births a year. There are 21,000 obstetrics and gynecology specialists. It’s estimated we need about 8,000 more obstetricians today. That’s before we consider the impact of bringing 600,000 to 800,000 live births forward.”
“We already experience a shortage of trained professionals. More importantly, this falls disproportionately on women of color and in this particular case, rural women. Access to care for rural women right now is very significantly limited. Fifty percent of women that live in rural areas are at least a 30-minute distance to the closest prenatal care.”
“You’re talking about increasing all the stresses on the existing system -- a system that today yields the highest maternal mortality rate in the civilized world -- stressing that system further with as much as 20 to 25 percent additional births. No planning in place to do that, no guarantee that care will be provided free of cost, yet an imposition of the state government’s will that you must do it.”
ON THE IMPACT OF A BAN ON OB-GYN TRAINING
Dr. Beverly Gray
“One of my concerns is training the next generation of physicians to care for women who have complicated pregnancy, who are experiencing miscarriage, who are presenting for abortion care. The impact this legislation could have on training is huge. The next generation of physicians may not be adequately trained to care for miscarriage, for abortion, for complications of pregnancy that arise in the mid-trimester. That’s definitely a concern.”
“It will influence where some of our best applications for OB-GYN apply for residency. For medical students who want to train and have the skills to provide comprehensive OB-GYN care, they’re going to be looking at states that can provide comprehensive OB-GYN care, and that includes abortion care. I definitely see how that can have a downstream effect as well.”
ON THE FREQUENCY OF PREGNANCY MISHAPS
Dr. Beverly Gray
“Every single week, we’re caring for patients who have an emergency, who have a medical condition where pregnancy will put their lives in grave risk.”
“We’re seeing those cases every week. We receive referrals, we have patients who are transferred in, and these are hard cases. Luckily, we have skilled providers. If you walk in the doors of Duke Hospital and you have an emergency in pregnancy, we are skilled to take care of that. I do worry about the impact over time if people aren’t able to access care when it’s safest.”
ON HURDLES FACING DOCTORS
Dr. Jonas Swartz
“Already, in North Carolina, we have seen the requirements that the state imposes on how we declare a medical emergency to perform some abortions impedes care. Policy will require that you get two doctors to sign there’s sufficient medical risk to supercede the state’s 72-hour waiting period. Just for context, North Carolina has a three-day waiting period, which is among the longest in the nation, where women have to receive counseling and then can receive an abortion.”
“When we want to perform an abortion for someone whose health is highly at risk before that three-day window, we need the certification of two doctors. Those sorts of restrictions make people scared to practice good medicine.”
Dr. Beverly Gray
“It’s hard for a provider, when they’re put into this very difficult situation where there’s vague language around the law that says a person’s life has to be ‘imminently’ at risk.”
“Anything that gives a provider pause in providing life-saving treatment will end in death. And that, unfortunately, is what we will see. Patients’ lives are on the line here.”
Dr. Richard Shannon
“I am very concerned about some of the stories we’re beginning to hear in states that are considering these restrictions. Individuals are advocating that abortion be considered homicide. Not only might a provider find themselves at risk of some civil litigation but potentially some criminal litigation.”
“One begins to see this process moving more and more to that way of thinking, and it’s been articulated by some state governors.”
“The idea that providers might be faced with criminal liability is going to further erode a doctor’s ability to act in the best interests of his or her patients. This is a step far, far, far too far for a government to go in insinuating itself in these incredibly complicated circumstances.”
ON MYTHS, CONFUSION ABOUT ABORTION
Dr. Jonas Swartz
“People aren’t aware of regulations about abortion in their state. What that tells us is that people don’t necessarily understand what’s at stake here, and the rights they’re losing. Or what people already have to go through if they end up needing an abortion.”
“Many people believe abortion to be less safe than childbirth. In fact, abortion is safer than childbirth. There are several states, including North Carolina, that have mandated scripts abortion providers are required to read to patients before performing an abortion. North Carolina’s does not, but some states do perpetuate myths within those scripts. So for example, some states suggest there’s an increased risk of infertility or an increased risk of breast cancer related to abortion. Both of those are myths.”
“The other common thing we hear is this discussion of fetal pain. Abortions are not occurring at a time in the pregnancy, after 28 weeks, when fetuses can feel pain. That is well scientifically established. Pain is a really complex neurologic response. Unfortunately, because that myth is perpetuated, we often see our patients worry about that. They care deeply about their bodies, they care deeply about these pregnancies.”
“The final myth that is often perpetuated about abortion is that it causes depression or causes adverse mental health outcomes.”
“It’s denial of access to abortion that causes people to have adverse mental health outcomes, not abortion itself.”
ON THE IMPACT OF AN ABORTION BAN ON SOCIAL SAFETY NET
Dr. Richard Shannon
“This will place enormous social burdens on our society. Important societal structures like foster care, which just provides incredibly important services to nearly 425,000 children across America, will be further stressed at a time when we really need to focus our efforts on meeting the fundamental needs of foster care today.”
“The idea that we could do much better if we focused on helping children who are born to live their full life is, to my mind, a more compelling social obligation than this tortious interference in the privacy of a woman and her decision whether or not to carry a fetus to term. There’s ample work but you can be certain these social safety nets will be further stressed.”
ON A BAN’S IMPACT ON ACCESS TO CARE
DR. Beverly Gray
“I worry about access to care for my patients, for my community, for those in surrounding states. And I worry about the suffering these laws will cause. If you have a uterus in this country, the rights of the potential life that uterus holds seem to be greater than the vessel that carries it. I’m more than a vessel. My daughter is more than a vessel. The patients I care for in my community are more than vessels.”
“We see what the potential ramifications of these legal changes are. I think it’s really important for people to understand what is real medical knowledge. What is fact, what is fiction. We need to dispel these myths.”
Dr. Jonas Swartz
“Unfortunately, I think that people are going to die. People are going to get sick. People are going to die because they potentially attempt unsafe abortions. People are going to die because they have complications of having to carry an unwanted pregnancy to term, and people are going to get sick from both of those things.”
“It’s terrible to think, in a time when we have this well-developed and safe technique that also helps people exercise their reproductive autonomy, that we’re just going to take away those best, evidence-based tools and expose people to higher risks.”
The Experts:
Beverly Gray, M.D.
Dr. Beverly Gray is an obstetrician and gynecologist, an associate professor in the Department of Obstetrics and Gynecology and founder of the Duke Reproductive Health Equity and Advocacy Mobilization team.
Contact: sarah.avery@duke.edu
Richard Shannon, M.D.
Dr. Richard Shannon is chief quality officer for Duke Health. He is responsible for the overall direction, leadership and operational management of the quality and safety programs of Duke Health.
Contact: sarah.avery@duke.edu
Jonas Swartz, M.D.
Dr. Jonas Swartz is an assistant professor in the Department of Obstetrics and Gynecology and a researcher in reproductive health equity issues, including a 2020 study finding that many women have minimal knowledge of abortion laws.
Contact: sarah.avery@duke.edu
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