Impacts of Overturning Roe v. Wade on Reproductive Health Care

On June 24, 2022, the Supreme Court of the United States (SCOTUS) overturned Roe v. Wade, the case that, since 1973, provided constitutional rights for abortions and reproductive health care. Returning that authority to the states (Duster et al, 2022), this ruling will have a devastating impact on women's physical and mental health. Thirteen states have “trigger laws” that ban or restrict abortions, some of which have already taken effect. In those states and possibly others, this decision will also impact many aspects of reproductive care and maternal health, including access to medical treatments such as assisted reproductive technology (ART), including in vitro fertilization (IVF), as well as preconception and prenatal genetic screening. This ruling is already impacting genetic testing and the provision of genetic services.

For nearly five decades, Roe v. Wade protected access to prenatal care and a woman's freedom to make a choice in a pregnancy outcome. Now, in some states, individuals who become pregnant unexpectedly, including by rape or incest, will not have the right to an abortion. Even in planned pregnancies, unexpected medical complications sometimes arise, and it is not clear how the law will be applied. An example is the case of Rachel Brown, a cancer patient in an early stage of pregnancy who could face serious health consequences should she not begin lifesaving therapy immediately. Her choices were to have an abortion to be able to start chemotherapy to fight her breast cancer or keep the pregnancy and decline the lifesaving therapy (Kolata, 2022). Another concern is the legal responsibility that physicians may face for treating patients after a miscarriage or for an ectopic pregnancy, should they even agree to treat those patients.

An ectopic pregnancy that is not treated in time can lead to the fallopian tube rupturing and can be life-threatening for the pregnant individual. In Texas, citizens can sue any individual who aides and abets any form of abortion, receiving $10,000 if they win their case (Bowman, 2022). Women could also be concerned with legal actions that can be taken against them after losing their fetus, whether intentional or not. Any medical record indicating an individual was pregnant and had lost the fetus could raise suspicions, especially if there is a record of a genetic anomaly in the fetus from prenatal screenings such as noninvasive prenatal testing (NIPT) or amniocentesis (Allyse and Michie, 2022). Pregnant individuals are less likely to obtain early prenatal care or decline prenatal genetic testing if they worry they could be prosecuted for any circumstances that might follow.

Moreover, certain lawmakers who support the overturning of Roe v. Wade claim that life begins at fertilization (Paul et al, 2021; Wingfield, 2022), therefore indicating that fertility care will be affected by the ruling too. Access to ART could be severely restricted in some states. According to the CDC, one in 50 children born in the United States annually is IVF conceived (ART Success Rates, 2022). It is devastating for individuals struggling to conceive to now also face legal restrictions on top of their physical limitations. In addition, access to preconception genetic screening may be impacted. Preimplantation genetic testing (PGT) is commonly done during IVF treatments.

Based on the PGT results, patients might choose to discard or donate their embryos. Suppose the ruling leads to states outlawing PGT due to the possibility of discarding embryos. In that case, many people will have to undergo more painful and expensive rounds of IVF since most abnormal and mosaic embryos do not implant. Sometimes, an abnormal or mosaic embryo can implant if its condition is compatible with life. Still, it either ends up in a miscarriage, a stillbirth, or a live birth of a sick child that, in some cases, will not survive past the first few years, weeks, or even the first hours of life. Thus, more prenatal monitoring and testing would be needed.

However, access to prenatal genetic screening may also be limited. Parents have utilized prenatal genetic screening to determine their fetus's risk of a genetic disorder. NIPT and amniocentesis, for example, test for fetal chromosomal abnormalities (Facts about Non-invasive Prenatal Testing |Kaiser Permanente, 2021; Amniocentesis—Mayo Clinic, 2020). In some of these states, clinicians are forced to order these tests earlier, when they are not as helpful, to allow for an abortion in the more narrowed timeframe stipulated by the state. In states with abortion bans, what options will the parents have if given a severe or fatal diagnosis? Before overturning Roe v. Wade, pregnant individuals in these situations would have two options, both heartbreaking. Either continue their pregnancy to term or terminate it. Now, in certain states, pregnant individuals will likely be forced to carry the fetus to term even if it will not survive long after birth.

In addition, the SCOTUS decision will also affect the American welfare system, ultimately forcing more children into foster care and live without a permanent family. In 1999, Levine et al postulated that a complete national recriminalization of abortion would result in ∼400,000 additional births per year. These data are still relevant today. In 2020, the Children's Bureau reported that there were >420,000 children in foster care, 20,000 of whom aged out of foster care without adoptive families (US Department of Health and Human Services, 2020). Some of them may be suffering from genetic diseases, and unable to receive proper medical care. In these situations, it is also likely that the biological parents might not have been able to provide adequate care either. According to Children's Rights (2022), an advocacy organization that protects and supports child's mental health, up to 80% of the children in foster care suffer from a mental illness, compared with about 20% of the children in the general population. Nonetheless, more children with genetic disorders will likely end up in foster care.

The overturning of Roe v. Wade exacerbates difficult situations and in some cases threatens the mother's life. This ruling impacts not only rights to abortion but also rights to preconception and prenatal care, the welfare system, and the mental health of the affected individuals. Nevertheless, pregnant individuals and their clinicians need to prioritize their own and their child's health in these times of uncertainty. This will no longer be possible in some states.

Thomas Jefferson said, “…laws and institutions must go hand in hand with the progress of the human mind.” That quote is chiseled into the wall of the U.S. Senate. The progress of the human mind includes new technologies, new information, and better decision-making. In this case, one branch of government has made a decision contrary to science and the welfare of women and children. Clinicians cannot do what they swore to do: “do no harm.” We can only hope that the legislative bodies in this land step up to correct this egregious assault on our rights as women and as a society.

Support organizations such as Planned Parenthood, Partnership for Women and Children, RESOLVE (the National Infertility Association), and the American Society for Reproductive Medicine (ASRM) can help individuals facing legal or clinical struggles.