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Abstract
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In June 2022, the U.S. Supreme Court issued its ruling in Dobbs v Jackson Women's Health Organization (1), which overturned Roe v Wade and eliminated the federally protected right to abortion. In the year since the decision, 14 states have made abortion illegal. The issue of abortion rights has become politically polarized, with both pro-life and pro-choice factions holding strong moral convictions about their viewpoints. Every state may now set its own rules regarding the legality of abortion, with consequent requirements for rapid change in reproductive health practices in some states. Texas is one of the most restrictive states, with the inclusion of Senate Bill 8 (2), which bans abortions after detection of embryonic cardiac activity--around 5-6 weeks after the start of the patient's last menstrual cycle--often before the woman realizes she is pregnant. The Texas Health and Safety Code Section 171.208 (3) bill additionally grants the right for any person in Texas to bring a civil action (with statutory damages no less than $10,000) as follows:
. . . against any person who performs or induces an abortion. . . [or] knowingly engages in conduct that aids or abets the performance or inducement of an abortion. . . regardless of whether the person knew or should have known that the abortion would be performed or induced.
The full ramifications of how these restrictive state laws may affect general medical health and mental health care remain ambiguous. The language of the Texas bill is vague, leading to concern by reproductive and mental health providers of potential legal liability if they discuss reproductive options with their patients. Some organizations in Texas have adjusted their rape crisis counseling services to offer less candid discussion about pregnancy options with women who have been raped and to be more vigilant about the potential for entrapment by anti-abortion activists (4, 5). Medical ethical principles for confidential doctor-patient communication and patient-centered treatment may also be in jeopardy (6). For example, Senate Bill 8 in Texas makes abortion illegal after 5-6 weeks and has no exceptions for rape or incest. Advocates for sexual assault survivors in Texas risk being sued if they offer an abortion referral to a survivor carrying a baby conceived through rape (5).
Women's advocates propose that the Texas law could trap people experiencing domestic abuse in their abusive relationships. A recent study (7) reported that mental distress has increased among women of reproductive age following the Supreme Court decision overturning Roe v Wade and new barriers to legal abortion. Rape resulting in pregnancy is a public health problem in which sexual violence and reproductive health connect. According to the U.S. Centers for Disease Control and Prevention's National Intimate Partner and Sexual Violence Survey, 2016/2017 Report on Sexual Violence (8), one in four women (26.8% or 33.5 million) reported experiencing a completed or attempted rape at some time (pg. 3). More than half (56.1%) of these women were raped by an acquaintance, more than one in three (39.3%) by an intimate partner, and about one in six (16.0%) by a family member (pg. 7). Almost half were first victimized as minors (pg. 11). It is estimated that one in seven of these individuals (almost 3 million women and girls) became pregnant. Two-thirds had ongoing concerns for their safety (pg. 14). These safety concerns are realistic, because women who are pregnant or have recently given birth are twice as likely to die by homicide than from any other cause of maternal mortality, most often at the hands of an intimate partner
Language: en |