What Overturning Roe v Wade May Mean for Assisted Reproductive Technologies in the US

The Alabama Embryo Decision-The Politics and Reality of Recognizing "Extrauterine Children"

This Viewpoint discusses the Alabama Supreme Court’s opinion on in vitro fertilization and how it plays into a larger push for fetal and embryonic personhood.

Early national trends in non-abortion reproductive care access after Roe

Background

Roe was overturned in 2022. No peer-reviewed evidence exists for the indirect spillover effects of overturning Roe on non-abortion reproductive care access for diverse patient populations.

Methods

National data were from 2013-2023 HHS Title X Directory, 2013-2020 CDC Artificial Reproductive Technologies (ART) Surveillance and 2021-2023 manual collection, and Guttmacher Institute. Outcome measures included numbers of ART clinics and Title X entities. Title X entities are those that receive federal funds to establish and operate voluntary family planning projects, especially for low-income patients. We reported pre-and post-Roe changes, associations between changes in measures and abortions, and characteristics of changed measures by region and political geography.

Results

Post-Roe America witnessed national declines of 1.03% in ART clinics and 18.34% in Title X entities, and average state decreases of 0.08 ART clinics (p < 0.05) and 18 Title X entities (p < 0.001). State-level ART clinic closures and abortion reductions had little association except for Texas, Oklahoma, Arizona, New York, and California. Plummets in Title X entities and abortions were positively associated: Reducing 100 abortions was associated with defunding two Title X entities (p < 0.05). The South experienced the largest losses of both, while 83.39% of lost Title X entities were in states that voted Republican in the 2020 presidential election, disproportionate to the 49.02% of states that voted Republican and the 42.52% of US population residing in these states.

Conclusion

We provide one of the first few evidence of spillover impacts of overturning Roe on non-abortion care access for diverse populations: low-income men and women, single parents by choice, and biologically and socially infertile patients. Early evidence warns of worsening challenges of inequities and calls for immediate policy actions.

Teaching Bioethics Today: Waking from Dogmatic Curricular Slumbers

The Dobbs decision has precipitated renewed medical, political, and professional interest in the issue of abortion. Because this decision handed responsibility for regulation of abortion back to the states, and because the states are enacting or have enacted policies that tend to be very permissive or very restrictive, the result has been legal and professional confusion for physicians and their patients. Medical education cannot resolve either the legal or ethical issues regarding abortion. However, medical education must prepare future physicians for caring for patients seeking abortion-related services. Physicians must be prepared to interact appropriately (sensitively and with integrity) with patients or colleagues whose views on abortion differ significantly from their own. This essay describes our educational effort to achieve that objective. The motto that governed this exercise was "No Easy Answers."

Preimplantation sex selection via in vitro fertilization: time for a reappraisal

In recent years, there has been rapid increase in the availability of elective sex selection via genetic testing of preimplantation embryos created through in vitro fertilization. We explore the standing of this ethically controversial practice in the context of a changing legal landscape after the Dobbs v Jackson Women's Health decision by the US Supreme Court.

The history and future of in vitro fertilization in the United States: the complex interrelationships among basic science, human medicine, and politics

Although much of the foundational basic scientific and clinical research was conducted in the United States, the first in vitro fertilization (IVF) birth occurred in the United Kingdom. Why? For centuries, all research surrounding the field of "reproduction" has elicited bipolar passionate responses by the American public, and the issue of "test tube babies" has been no different. The history of conception in the United States is defined by complex interrelationships among scientists, clinicians, and politically charged decisions by various branches of the US government. With a focus on research in the United States, this review summarizes the early scientific and clinical advances important to the development of IVF and then addresses the potential future developments in IVF. We also consider what future advances are possible in the United States given the current regulations, laws, and funding.

ASCO Ethical Guidance for the US Oncology Community Where Reproductive Health Care Is Limited by Law

The decision in Dobbs v Jackson Women's Health Organization overturned federal protections for abortion rights, making way for states to enact abortion bans with or without exceptions for the health or life of the pregnant patient. Patient care across many areas of medicine including oncology continues to be affected. Although the change in the legal landscape is widely felt, the core ethical considerations for physicians do not change because of restrictions on the practice of medicine. ASCO offers this guidance to assist US oncologists and institutions who must balance limitations with established ethical duties. This paper articulates principles for cancer care and pregnancy, offers a framework for ethical reflection and action for oncologists who care for pregnant patients, and makes recommendations for individual and institutional action to support evidence-based, patient-centered care in the United States where abortion is illegal or access is limited.

Derogada la sentencia Roe vs. Wade

Después de casi medio siglo fue derogada la sentencia del caso Roe vs. Wade por la Corte Suprema de los Estados Unidos, lo que puede suponer el fin del aborto en ese país. Se mencionan algunos antecedentes, hitos históricos, arreglos y el contexto de la situación que desembocó en la sentencia mediante la cual se estableció el derecho constitucional al aborto (Roe vs. Wade), se mantuvo la decisión tomada (Planned Parenthood vs. Casey) y finalmente cómo se revocaron las sentencias anteriores (Dobbs vs. Organización de Salud Femenina Jackson). Se concluye, desde una perspectiva biojurídica, que se corrigió un fallo no solo controvertido en su aplicación, sino sobre todo en su génesis, donde queda claro que el aborto no es un derecho constitucional y que los organismos judiciales no son competentes para regular sobre esa materia y sobre otras análogas. Desde el punto de vista bioético, es un fallo revocatorio histórico, que rectificó una de las mayores injusticias contemporáneas, que puso por encima la autonomía individual sobre el hecho biológico incontrovertible de una nueva vida humana y el cuidado que demanda su dignidad ontológica: Roe vs. Wade costó la vida a millones de embriones, en los Estados Unidos y en el resto del mundo.

Post-Roe emergency medicine: Policy, clinical, training, and individual implications for emergency clinicians

In June 2022, the United States Supreme Court decision Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade, removing almost 50 years of precedent and enabling the imposition of a wide range of state-level restrictions on abortion access. Historical data from the United States and internationally demonstrate that the removal of safe abortion options will increase complications and the health risks to pregnant patients. Because the emergency department is a critical access point for reproductive health care, emergency clinicians must be prepared for the policy, clinical, educational, and legal implications of this change. The goal of this paper, therefore, is to describe the impact of the reversal of Roe v. Wade on health equity and reproductive justice, the provision of emergency care education and training, and the specific legal and reproductive consequences for emergency clinicians. Finally, we conclude with specific recommended policy and advocacy responses for emergency medicine clinicians.

Repercussions of overturning Roe v. Wade for women across systems and beyond borders

June 24th, 2022, a day that will be etched in today and future generations’ textbooks as a historic day, the United States of America revoked the constitutional right to seek safe abortion care. Overturning Roe v Wade allowed the divided individual states to independently decide the legal parameters regarding abortion care. A decision that disproportionately effects the reproductive lives of women residing on the land of America. Given the systemic impacts of racism, neoliberalism and white supremacy, it is the Black, racialized and poor women who suffer terrible repercussions. In this commentary the authors begin by discussing the historical biopolitical perspective, colonial systems and longstanding impacts on racialized women’s bodies in America. The discussion transitions to the implications of geopolitics at play nationally and cascading impacts globally, focusing on humanitarian and emergency settings. Using a medical humanities perspective, authors highlight the collision between politics and reproductive health policy and its implications on social determinants of health, such as women’s education, employment, housing, racial and gender equity and wellbeing. Long standing advocates, community leaders and healers, leading scientists, birth attendants, doctors, nurses, allied health professionals/providers and humanitarian workers – and many others - are reminded and live the weight of the continuous battle of population control, stemming from the oppressive history of control and exploitation.