Yang, Greene and Matsunaga: Defining an Emergency Post-Roe

In the wake of Dobbs v. Jackson Women’s Health Organization — the US Supreme Court decision overturning Roe v. Wade — many are wondering how to support doctors and clinics in states where abortion is now illegal. Our professors of obstetrics and gynecology at the Geisel Medical University have come up with an idea: donate blood. As access to abortion becomes scarce, doctors expect an increase in patients with life-threatening bleeding when treating pregnancy complications such as an ectopic pregnancy. As many people have to travel long distances to get the care they need, and as providers in states where abortion is still legal become busier, we are likely to see an increase in self-induced abortions without the trained help of medical providers. These procedures can increase preventable complications, including excessive bleeding, which would require the use of donor blood supplies, which are already in high demand.

With no federal protections for abortion rights, many states have implemented strict bans, with exceptions only for medical emergencies. Although these laws imply that there is a clear definition of a medical emergency, in reality this is rarely the case.

In an ectopic pregnancy, an embryo grows outside the uterus and is by definition non-viable. Ectopic pregnancies occur in places that cannot accommodate a growing embryo, such as the fallopian tubes, which are small structures designed to carry eggs from the ovaries to the uterus. The continued growth of the embryo can cause significant damage to surrounding structures, leading to complications such as ruptured fallopian tubes and life-threatening internal bleeding. Typically, doctors treat ectopic pregnancies with an abortion as soon as possible, before the embryo grows too large and complications such as bleeding occur. Since Dobbs, however, new state laws with narrow exceptions to what constitutes a legal abortion have created confusion and despair among physicians. Abortion providers are now forced to ask questions like is that person’s life threatened enough to do so Emergency? Should I call an attorney before I take this patient to surgery? Do I lose my license if I treat it?

As medical students entering the profession early, it is disturbing to hear of the far-reaching consequences of Roe’s upset. Caring for miscarriages and treating dangerous infections in the uterus can pose legal challenges that threaten the livelihoods of physicians in states where abortion is now virtually illegal. In addition, many drugs that can be used for abortion, such as methotrexate, are also used to treat other conditions, such as rheumatoid arthritis and lupus. Inadequate review of prescriptions for these drugs not only impacts access to abortion care, but also has adverse effects on people with these chronic conditions, most of whom are women of childbearing age. The impact of declining access to abortion will also disproportionately hit marginalized communities, such as people of color and those of low socioeconomic status.

According to the CDC, more than half of abortions in 2019 were performed by people of color, a population with greater overall barriers to accessing health care. These barriers are multiple, including a higher likelihood of being covered by public health insurance like Medicaid, which offers limited abortion treatment under the Hyde Amendment, fewer financial resources and the ability to travel for treatment, and racism and discrimination in dealings with the healthcare system. It’s also important to note that pregnancy itself is by no means benign, especially in the United States where maternal mortality has actually increased in recent years. In addition, pregnancy-related mortality is higher among Black and Alaskan Native American/Indigenous populations than among White populations, and further restricting access to abortion is likely to exacerbate these pre-existing health disparities. Practicing medicine in states that prohibit abortion requires physicians to decide what qualifies as an emergency in order to provide necessary care. In the United States, where childbirth actually carries a higher risk of death than a legal abortion, carrying a pregnancy to term could be considered an emergency. Forcing doctors to make impossible decisions in the face of legal scrutiny will likely mean pregnant patients receive inferior care as their doctors try to avoid legal gray areas. It will also mean that many current and future physicians will shy away from frontline specialties where they might face such situations.

In 2021, New Hampshire introduced the first abortion restriction in state history by banning abortion at 24 weeks. While abortion before the 24th week of pregnancy is currently safe and legal, the loss of constitutional protection for abortion means that this right is not guaranteed. It is not unreasonable to imagine that in the future state legislatures will propose more restrictive abortion laws, which could have numerous consequences outside of abortion. Today, it’s more important than ever for Granite Staters to elect state legislators who promise to protect reproductive rights in New Hampshire. And as we continue to fight for our right to basic medical care like abortion, consider donating blood to care for those experiencing complications as a direct result of anti-choice legislation.

Ashley Yang, Lily Greene, and Sarah Matsunaga are students at the Geisel School of Medicine who will graduate in 2024. This column was written with the support of Katie Allan Med’24, Carly Ratekin Med’24, Maggie Sherin Med’24 and Delaney Taylor Med’24. The views and opinions expressed here are not necessarily those of Geisel and may not be used for advertising or product recommendation purposes.

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