Viewpoint: Health systems must start planning for end of Roe v. Wade now

If the Supreme Court overturns Roe v. Wade, the criminialization of abortion will have a systemwide effect on the healthcare industry — a potenital reality health systems must start preparing for now, Lisa Harris, MD, PhD, wrote in a May 11 article for The New England Journal of Medicine.

Michigan Medicine has been preparing for the loss of abortion care since December, according to Dr. Harris, who is a professor of obstetrics and gynecology, and womens and gender studies at the University of Michigan in Ann Arbor. If Roe v. Wade is overturned, Michigan would revert to a 1931 law that's among the strictest in the country, only permitting clinicians to provide "life preserving" abortion care, she said. 

"Most will not 'qualify' for abortion under Michigan's law and will have only three options: leave the state for care, self-manage an abortion, or give birth," she wrote. "All three have enormous effects on health systems, including primary care and subspecialist care across adult and pediatric settings."

Dr. Harris said health systems in states with abortion bans should prepare to offer patients referrals and other services, such as ultrasounds and bloodwork, for those who can leave the state to seek care where it's legal. They must also determine whether neighboring states will have capacity for patients who require hospitalization and create plans for transferring hospitalized patients across state lines.

As some patients may not be able to travel out of state or access medications that induce abortion, health systems should also consider creating a harm reduction strategy to prevent people from engaging in ineffective or dangeorus abortion methods.

Maternal mortality will also likely increase as more women give birth, underscoring the urgency of addressing systemic inequities that disproportionately affect pregnant people of color, according to Dr. Harris.

"Health systems that view abortion exclusively as a political or partisan issue, perhaps one they'd like to avoid, will soon bear witness to the reality that abortion care, or lack thereof, is a healthcare and health equity issue," she concluded. "Avoiding the issue will not be possible, short of abandoning care and equity missions altogether. Thoughtful preparation is needed now."

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