If Roe falls, some fear for reproductive care
If the Supreme Court follows through on overturning Roe v. Wade, abortion likely will be banned or greatly restricted in about half the U.S. states. But experts and advocates fear repercussions could reach even further, affecting care for women who miscarry, couples seeking fertility treatments and access to some forms of contraception.
Many conservatives insist they are only interested in curtailing abortion, and legislation passed so far often has exceptions for other reproductive care. But rumblings from some in the GOP have experts concerned, and laws banning abortion could also have unintended side effects.
“The rhetoric has been really increasing over the last several years,” said Mara Gandal-Powers, the director of birth control access at the National Women's Law Center. “There's definitely a domino effect which I think people are really starting to wake up to and see this is how far it could go.”
If Roe is overturned, as suggested by a leaked draft opinion, states will set their own abortion laws, and conservative lawmakers are already passing a steady stream of deeply restrictive regulations. Oklahoma lawmakers, for example, passed legislation Thursday banning abortion at conception, the strictest in the nation.
Although that bill has some exceptions, it signals a direction that is deeply worrisome for many doctors.
“I truly think the people writing these laws either have no concept of the broad implications or do not care about how this impacts so many aspects of women's health care,” said Dr. Kristyn Brandi, a New Jersey OB-GYN who provides abortion care.
“In medicine, you are not considered pregnant until this fertilized egg is implanted into the uterus — which happens after fertilization,” Brandi said. She said it is unclear whether doctors performing infertility treatments would be in violation of the law if they dispose of extra fertilized eggs. The Oklahoma measure “is not based in science and is incredibly confusing and frustrating for medical professionals trying to provide evidence based care.″
The Roe decision was based on a constitutional right to privacy — and the decision leaned on another landmark case eight years earlier that gave married couples the right to birth control, Griswold v. Connecticut.
Reliable birth control is now a feature of life for millions of Americans, but in March U.S. Sen. Marsha Blackburn of Tennessee recorded a video message naming the Griswold decision as “constitutionally unsound.” She's not proposing restrictions on birth control but hasn't commented further to clarify what she meant.
Other conservatives have conflated emergency contraception, often known as the morning-after pill, with abortion. In Idaho, for example, it was prohibited at school-based health clinics last year under a law banning public funding for “abortion related services.”
Along with long-acting birth control devices called IUDs, emergency contraception has been been attacked by abortion foes who believe life begins when an egg is fertilized.
But those pills have no effect once a pregnancy is established, after implantation in the womb, Brandi said.
“You can take Plan B all you want when you're pregnant. It will not do anything to your pregnancy,” she said.
Emergency contraceptive pills like Plan B and IUDs may also prevent a fertilized egg from implanting in the womb, but experts say the science on that isn't clear. It is believed they mostly work by blocking fertilization.
Political attempts to block access to intrauterine devices and other birth control “would be consistent with the pattern that we're seeing right now,” said Dr. Jennifer Kerns, an associate professor at the University of California, San Francisco who also provides abortion care. “Many of us are very concerned that that's kind of the next up on the chopping block.”
In Missouri last year, for example, there was a failed effort to prevent IUDs and emergency contraception from being paid for by Medicaid. But in Tennessee, which just passed harsh penalties for providing abortion medication, Republican Senate Speaker Randy McNally pushed back on any suggestion that contraception could be in the crosshairs.
“Contraception and abortion are not the same thing. One is a responsible way to prevent pregnancy. The other ends a human life. It is a flagrant attempt to change the conversation and it won't work,” spokesman Adam Kleinheider said in a statement.
The governor of Mississippi, one of 13 states that will immediately ban abortion if Roe is overturned, wouldn't say whether he'd sign a hypothetical birthcontrol ban when asked on “Meet the Press.” Gov. Tate Reeves later clarified on Twitter: “I'm not interested in banning contraceptives.”
But doctors also worry other forms of reproductive care, like treating ectopic pregnancies, could be targeted. These occur when a fertilized egg implants outside the uterus, often in a fallopian tube. They are often life-threatening medical emergencies because the fragile tube can rupture, causing massive internal bleeding.
In 2019, an Ohio Republican proposed a measure that would have compelled doctors to try transplanting ectopic pregnancies into the uterus or allowing insurers to cover the hypothetical procedure, which is considered medically impossible.
After Texas banned abortion after six weeks, Kerns said colleagues there have told of patients with ectopic pregnancies being transferred out of state for treatment, putting their health at risk.
Physicians may even become hesitant to treat miscarriage, said Brandi, the New Jersey OB-GYN.