Like many Americans, I was shocked by the leak of the Supreme Court’s proposed ruling that could overturn Roe v Wade. My shock was quickly replaced by concern for the medical care of millions of women in the United States. If the regulation of abortion is returned to the states, we will be turning back the clock 40 years along with advances in women’s health.

The United States has the highest maternal mortality rate of any developed country. In 2020, the maternal mortality rate was 23.8 deaths per 100,000 live births, according to the Centers for Disease Control and Prevention. Carrying a pregnancy to term is 33 times riskier than having a legal abortion; the case-fatality rate was 0.41 maternal deaths per 100,000 legal abortions between 2013 and 2018.

More than half of states are set to begin banning some form of abortion soon after the Supreme Court’s final ruling. This would include banning termination of pregnancy if there is a fetal heartbeat, even in the case of an ectopic pregnancy or in the early stages of a miscarriage, said Alisa Goldberg, MD, MPH. “Many state bans have removed the health exception and only left in place life-threatening medical emergencies, which means that patients are going to be forced to get sicker before a clinician will be willing to terminate the pregnancy,” she said in an interview.

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One safe alternative to surgical abortion is medication abortion, which has been available since 2000 when the US Food and Drug Administration (FDA) approved the use of mifepristone for nonsurgical abortion of early pregnancy. Use of mifepristone alone and in combination with misoprostol are the only regimens recommended by the American College of Obstetricians and Gynecologists (ACOG) for the medical management of early pregnancy loss. But even these measures are being threatened. Lower courts have declared that banning medication abortion outright is unconstitutional but other state-level restrictions have gone into effect without legal challenge.

ACOG also endorses the use of telemedicine for providing medication abortion services. The use of telemedicine is expected to increase after state bans are enacted, but access will depend on the patient’s ability to travel to states where abortion is legal, putting women’s health at risk.

Nikki Kean, Director
The Clinical Advisor