More than a year after the U.S. Supreme Court’s decision in Dobbs vs. Jackson Women’s Health Organization, healthcare leaders are dealing with a wide range of effects. Early indications show the impact on women’s health beyond reproductive issues will be significant, as well. According to ABC News, the consulting firm SG2 estimates we will see over 150,000 new live births, with at least 17,000 being pre-term births that make an unknown impact on nursery intensive care. Nearly half of all abortions are to patients living below the poverty line, potentially exacerbating existing patterns of poverty and exclusion in states with historic antipathy toward funding social services. Obstetricians-gynecologists are showing reluctance or refusing to move to or stay in states with abortion bans, contributing to the rash of hospitals closing or announcing the closure of labor and delivery services in states with abortion restrictions.
Healthcare systems are going to face significant increases in pressure around emergency contraception and preventive health services consequent to the patchwork of state laws and proximity to emerging maternal health deserts no matter where you are located. Costs associated with the uncertainty around legal rules for maternal care, including liability and litigation expenses, are going to make your choices challenging and your determination to provide quality women’s healthcare rife with complexity.
So, what can healthcare leaders do in the face of this conjunction of forces?
- Know the laws in any jurisdiction in which you provide care. Legal guidance is going to become even more important as laws are established and as various suits unfold around the country.
- Ensure that you invest adequately in educating staff and patients continuously in this fluid environment. If you are faced with different rules across states, make certain that the differences in requirements and remedies are clearly communicated and that staff can clearly express to each other and patients what they are.
- Review and realign your policies and practices in the intersection between the legal requirements or restrictions of the states in which you operate and your values and mission. You may find that you are faced with moral dilemmas in the provision of care, and the first casualties may be the front-line medical staff. Provide the medical staff with education about the laws and have their backs about providing necessary patient care in the face of huge uncertainty. Don’t leave them unsupported in the care of patients.
- Engage in the conversation about policy with lawmakers and those responsible for enforcing the laws. The real consequences for women’s healthcare and the care of children are seen in the data you collect. Your government affairs staff needs to be equipped to help educate lawmakers and others about unwanted effects of laws enacted in a hurry. Senior medical and administrative leadership should be assiduous in working to shape laws and policies that improve care, especially for women and those populations known to suffer poorer health outcomes.
- Design support services that can address the needs of patients caught in the crossfire between their personal situation and extant legal requirements. This may mean that you provide referrals for services that you will not or cannot perform. It may mean that your strategic care includes ways to maximize legal options when your organization serves multiple geographic regions.
The worst outcome of the current political confusion would be losing sight of the real patients who are confused and anxious about what it means for them and their families. As healthcare leaders we have access to resources and information that can put patients’ needs at the forefront of our concerns. We have a moral and legal obligation to ensure that all people have access to safe and legal health services, including reproductive healthcare, no matter what specific state regulations may interpose.
Douglas Riddle, PhD, DMin, is curriculum director, The Carol Emmott Foundation.