In the aftermath of the U.S. Supreme Court’s reversal of Roe v. Wade, a ruling that previously established federal protection for patient autonomy in reproductive decision-making, state governments across the nation encountered a pivotal inflection point in reproductive health policy. This juncture signified more than a legal transformation; it represented a fundamental shift in the medical landscape, directly impacting the ability of individuals to exercise their reproductive rights. In the recent 2023 midterm elections, Ohio and Virginia emerged as critical arenas in the discourse on the preservation of reproductive autonomy.

Ohio voters approved Issue 1, an amendment that guarantees individuals’ rights to make their own reproductive decisions, including personal choices on abortion, up until the point of fetal viability (1). Fetal viability refers to the point at which a fetus can survive ex-utero and is defined by Ohio law as 21 weeks and 6 days. The Issue 1 amendment aimed to prevent the reinstatement of SB23, the most recent six-week state abortion ban based on fetal heartbeat detection (2). The direct vote on abortion regulations marked a departure from previous abortion restrictions and a victory for reproductive rights in Ohio.

Similarly, Virginia saw a significant development in the protection of reproductive rights legislation with a political shift establishing a Democratic majority determined to counteract future abortion restrictions. Currently, Virginia’s abortion laws, 18.2-72 and 18.2-73, legalize most abortions until the end of the second trimester, which aligns with the recent amendment proposed in Ohio (3). Recent efforts by Republican legislators have threatened these rights by pushing for a 15-week abortion ban. However, the Democratic sweep during the Virginia midterm ensures the preservation of the current abortion rights within the state.

These recent legislative advancements demonstrate significant implications for practicing providers and research focuses. For providers, the reversal of abortion restrictions restores their full scope of practice and guarantees adequate training in complex abortion care. As reproductive rights continue to evolve, healthcare providers have a responsibility to stay informed on state policy changes and abortion practice guidelines. The implementation of Texas SB8, which prevents providers from offering abortion as an option if a fetal heartbeat is detected, serves as a resounding example of the complexities introduced into the counseling process for healthcare providers. Grappling with insurance and institutional limitations that restrict patient eligibility for hospital-based care, providers are faced with increasing uncertainty on the conditions for which abortion should be considered (4).

In addition to awareness of state-specific legislation, physicians must be committed to advocating for accessible training and comprehensive education on abortion provision. A comprehensive review of abortions in the U.S. concluded that abortions are safe and effective, with rates of complications below 1%, significantly lower than those associated with childbirth (5). Recent studies show that one in five physicians are not confident that abortions are “very or extremely safe,” underscoring gaps in current provider knowledge (6). Ensuring that providers are adequately informed on both legislative and clinical fronts, along with understanding current limitations and opportunities for improved education, is crucial to protecting patient safety and working towards safeguarding provider access to training regardless of the state they go on to practice in.

Research also continues to remain a vital front in evaluating patient safety, psychological impacts, and long-term health outcomes for individuals accessing reproductive care in states with restrictive abortion policies. The shifting legislative landscape, such as recent amendments in Ohio, underscores the growing necessity for such research. Rigorous research guides evidence-based practice standards, and serves as a tool to identify critical gaps in healthcare provision, particularly in the context of complex pregnancies. Another area warranting active research is the impact of abortion costs on patient safety and morbidity. Before the Dobbs decision, three quarters of abortion patients, falling at or below 200% of the federal poverty level, depended on individual state jurisdiction on the use of Medicaid funds for abortion services, given that the Hyde Amendment prohibits federal Medicaid from covering most abortion procedures (7). Considering the role that financial barriers play in the ability to receive abortion care both in and out of state, it is increasingly important to assess the intersection between social determinants of health and the inability to undergo a desired abortion as state laws change.

The legislative developments in Ohio and Virginia mark a significant step forward in preserving reproductive rights. These developments also highlight the transient nature of the current abortion legislative landscape, indicating the urgency to enact federal legislation that codifies the protection of individuals seeking abortion care. Advocacy for nationwide efforts to expand access to abortion care is necessary but must also be supplemented by education among abortion providers and continued research on the downstream effects of the Dobbs decision. Physicians bear the utmost responsibility to safeguard patient outcomes, and engage in legislative discourse and action that ultimately supports a patient’s right to bodily autonomy.

References

(1) Ohio Secretary of State. Issue 1: A Self-Executing Amendment Relating to Abortion and Other Reproductive Decisions. Columbus, OH: Ohio Secretary of State; 2023. Available here.
(2) Ohio General Assembly. Senate Bill 23: Human Rights and Heartbeat Protection Act. 133rd General Assembly, 131st General Assembly Regular Session. Columbus, OH: Ohio Legislature; 2019. Available here.
(3) Virginia General Assembly. Code of Virginia: Article 9. Abortion. Richmond, VA: Commonwealth of Virginia; 2023. Available here.
(4) Arey W, Lerma K, Carpenter E, Moayedi G, Harper L, Beasley A, et al. Abortion access and medically complex pregnancies before and after Texas senate Bill 8. Obstetrics & Gynecology. 2023;141(5):995–1003.
(5) The National Academies of Sciences, Engineering, and Medicine, Committee on Reproductive Health Services. The Safety and Quality of Abortion Care in the United States. Washington (DC); The National Academies Press; 2018. Chapter 2, page 56.
(6) Swan LET, Cutler AS, Lands M, Schmuhl NB, Higgins JA. Physician beliefs about abortion safety and their participation in Abortion Care. Sexual & Reproductive Healthcare. 2023 Dec;38:100916.
(7) Weitz TA, O’Donnell J. The challenges in measurement for abortion access and use in research Post-Dobbs. Women’s Health Issues. 2023 May 22;33(4):323–7.