Erosion of women’s reproductive rights in the United States

The BMJ editorial is compelling and ironic in equal measure(1). Montgomery v Lanarkshire Healthcare Board 2015 was thought to be the obituary for the doctor dictator(2). However it is apparent just how easy it is for doctors, under the auspices of one of the most high profile medical journals in the world, to revert to the paternalistic medicine of yesteryear; dictating to national democracies, women and their peers what they must believe with regard to abortion. If they do not comply they are draconian. There is no consensus, neither within society nor amongst doctors, regarding abortion. The most recent polls in the US confirm that the topic continues to polarise opinion. The 2018 Gallup poll showed that 43% believe abortion should be legal in most or all cases, while 53% hold the view that abortion should be illegal in most or all cases(3). In the face of this dissensus, it is not the role of doctors to proselytise or demand society to adopt a particular view.

The author raises concern that the societally disenfranchised may be particularly vulnerable where abortion access is restricted. Abortion rates remain disproportionately high amongst of women of lower socio-economic status and ethnic minority women(4). The US Centers for Disease Control (CDC) report that in 2015 there were 111 abortions per 1000 live births amongst non-Hispanic white women. This figure was astronomically high at 390 abortions per 1000 live births amongst black women(4). The 2018 US Census shows that non-Hispanic white population accounts for 79% of the overall US population but only 37% abortions. The black population accounts for 24% of the US, but an astonishing 36% of abortions(4,5). This disparity requires urgent attention from our profession. Women’s health is not served by using this very inequality as a justification for the existence of abortion. Tellingly the most common reason women give for requesting an abortion is poverty, with up to 74% citing this as a primary motivation(6). If the reason for abortion is poverty, the solution is not abortion, but the equitable distribution of resources and measures at tackling poverty. As a profession we must address the burden of poverty of which abortion is a symptom. Promoting access to abortion cannot be proffered as an aide or worse still solution to poverty or discrimination.

Society and public perception of abortion has changed, in some quarters, since Roe v Wade 1973 and the Abortion Act 1967. This is possibly, in part, due to the ubiquitous use and wide distribution of graphic prenatal imaging, showing foetuses apparently engaging in behaviours normally associated with infants, such as stretching and yawning(7). These impact upon public perception of the pre-birth existence(7). As a profession we must be receptive to this shift in mood. Doctors have a role in the abortion debate, but we must do so as doctors and not lawyers or politicians. This does not involve an exposition of the dynamic legal panorama or championing the views of women from the 1960s and 1970s, but rather listening and engaging with society and women of the 21st century.

1. Aiken ARA. Erosion of women's reproductive rights in the United States. BMJ. 2019 Jul 5;366:l4444
2. McCombe K, Bogod DG.Paternalism and consent: has the law finally caught up with the profession? Anaesthesia. 2015 Sep;70(9):1016-9.
3. https://news.gallup.com/poll/244097/legality-abortion-2018-demographic-t...
4. https://www.cdc.gov/mmwr/volumes/67/ss/ss6713a1.htm
5. https://www.census.gov/newsroom/press-releases/2019/estimates-characteri...
6. Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM.Reasons U.S. women have abortions: quantitative and qualitative perspectives. Perspect Sex Reprod Health. 2005 Sep;37(3):110-8.
7. Roberts J. The Visualised Foetus: A Cultural and Political Analysis of Ultrasound Imagery 2012 London, Routledge.