Six Commentaries on Improving Access and Equity in a Post-Dobbs World

June 23, 2023

With the Supreme Court behind them, protestors hold signs reading "Bans off our bodies" and "I love someone who had an abortion"

WASHINGTON, DC (June 23, 2023)—One year after the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision stripped the federal right to abortion from millions of people, researchers, scholars, advocates, and providers are still evaluating the unfolding ramifications of the reversal of 50 years of national legal protections. Women’s Health Issues asked six teams of thought leaders in the field of abortion and health to provide their informed perspectives on the current and downstream implications of this landmark decision and offer recommendations.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University. The following six commentaries are online as articles in press and will appear in the journal’s July/August issue: 

The Challenges in Measurement for Abortion Access and Use in Research Post-Dobbs: Improving abortion access requires understanding who has it and who needs it. In the first commentary, Tracy A. Weitz and Jenny O’Donnell explain that measurement of U.S. abortions was inadequate before Dobbs and will now become far more challenging as abortion care is criminalized in many states. Traditional measures of abortion access and use have not sufficiently accounted for the many barriers besides geographic distance that often confront those seeking abortions, nor have they kept up with the shift to receiving abortion medications by mail. Weitz and O’Donnell call for the federal research apparatus to stop leaving funding of this work to private philanthropists and to instead lead efforts to strategize and strengthen our abilities to provide accurate and reliable abortion data.

Abortion Bans Will Exacerbate Already Severe Racial Inequities in Maternal Mortality: Research has made clear that the changes in abortion provision and access in the United States will disproportionally impact populations that already experience health and systemic inequities because of structural racism. In their commentary, Kelly M. Treder, Ndidiamaka Amutah-Onukagha, and Katharine O. White warn that the intersection of reproductive injustice and the U.S. maternal mortality crisis will lead to an inequitable increase in maternal morbidity and mortality. They write that for Black, Latinx, and American Indian communities, the post-Dobbs slashing of abortion access “is a contemporary manifestation of the reproductive oppression these communities have experienced for centuries at the hands of a health care system that was not designed to center them or their needs.” To mitigate the harms abortion restrictions cause, these authors call for support for abortion funds, enhanced legal protections, high-quality obstetric care tailored to communities of color, and expanding access through medication abortion and telemedicine.

The Provision of Medication Abortion Care Via Telehealth: Divya Jain, MiQuel Davies, Jamila Perritt, and Jennifer Blasdell focus on the provision of medication abortion care via telehealth and outline what telehealth can currently do to ensure access to abortion care as well as what is needed to increase and sustain access for all persons across the United States. They discuss survey findings regarding barriers providers face to offering medication abortion via telehealth and recommend ways institutions can reduce these barriers, such as by establishing protected clinical time for providers to offer telehealth care, freeing providers from responsibilities related to stocking the abortion drug mifepristone, and carrying appropriate liability insurance. The authors also recommend governmental intervention at the state and federal levels, such as the passage of bold legislation like the Women’s Health Protection Act to protect clinicians and their patients seeking abortion care.

Impact of the Dobbs Decision on Medical Education and Training in Abortion Care: The training of medical providers in medication abortion is one piece of overall training needs that will be impacted by the Dobbs decision, as noted in a forward-thinking commentary by Stephanie J. Lambert, Sarah K. Horvath, and Rachel S. Casas. States that ban abortion severely limit vital clinical experiences for their medical students and residents, and not just those training in obstetrics and gynecology. The lack of exposure to and training on abortion in restrictive states will undoubtedly harm patient care and population health, the authors warn, as trainees see abortion-banning states as less desirable residency destinations or face hurdles to learning the skills necessary for treating miscarriages (which are the same skills needed for performing abortions). Lambert and colleagues recommend partnerships between residency programs in states with protected access to abortion care and restrictive states, expansion of abortion care training in primary care and emergency medicine, growth of residency and fellowship programs that support abortion training in obstetrics and gynecology, and improvements to medical education.

A Focus on Contraception in the Wake of Dobbs: Another downstream implication of restrictive abortion policies is higher barriers to accessing contraception. Alina Salganicoff and Usha Ranji write, “The new barriers that abortion bans present for those who want to prevent pregnancy are compounded by ongoing gaps in contraceptive financing, limited options and access points, and mis- and disinformation about sexual and reproductive health.” They explain that meeting the challenge will require a multiprong approach that includes increasing financing, focusing on equity, improving options (e.g., with pharmacist-dispensed and over-the-counter oral contraceptives), and providing accurate information about sexual health to all.

Rebuilding a Reproductive Future Informed by Disability and Reproductive Justice: Asha Hassan, Alanna E. Hirz, Lindsey Yates, and Anna K. Hing urge our field to take this moment in history as an opportunity to do better, especially by the one in four persons living with a disability, who are too often sidelined. They write: 

“Reproductive bodily autonomy cannot orbit solely around the legal right to abortion care. In line with upstream public health approaches designed to address root causes, medically accurate and judgment-free reproductive counseling must begin early in the lifecourse, not just at the discovery of an unwanted pregnancy. Having providers and educators who recognize people with disabilities as whole individuals with reproductive and sexual lives, goals, and futures is a significant and impactful change that can be championed in several ways.”

Although there are no simple or easy solutions, Hassan and colleagues recommend investments in disabled scholars and redistribution of power to achieve the autonomy at the core of both reproductive and disability justice.

“Together, these commentaries remind us that the pre-Dobbs world was an inequitable one, and our responses to this disastrous decision must aim to do more than return to the status quo,” write Women’s Health Issues editor-in-chief Karen McDonnell and managing editor Liz Borkowski, both of Milken Institute SPH, in an Editor's Note about the commentaries. “The six pieces offer viewpoints, recommendations, and approaches to ensure not only access to abortion but progress toward health and justice.”